Provider360™ Data Services

Optimize provider data

Provider360 Data Services offer a suite of solutions that can help keep your files updated and maintained to better serve your members, network providers and meet regulatory requirements.

If your health plan is looking for a cost-effective outsourcing solution to improve your provider database, Optum™ can provide a full range of standard or custom services to meet your specific needs.

Optum offers:
  • More than 25 years of experience in data services
  • Time-proven methodologies
  • Access to best-in-class provider databases including dentists, Medicare and Medicaid physicians and other key health care professionals

General solutions

File aggregation and cleaning

Optum collects your disparate provider data files, cleans and standardizes their contents and combines them into a single, uniformly formatted file. Provider and address duplication is removed, resulting in a single record for each provider-address combination. Additionally, Optum references each individual provider back to your original files so you can locate where the same provider is populated throughout your disparate file sets.

Comparison, correction and augmentation

Sophisticated algorithms are employed to match your provider data file to our Provider360 databases. Then, each data element from your file is compared against Provider360 data to identify and correct invalid, incorrect and outdated data. After empty fields in your file are filled in, Optum provides additional data that you may be missing.

Data verification services

Avoid the hassle of managing your own costly data verification outreach programs by outsourcing provider data verification and collection. Optum directly contacts provider offices through phone, fax, email and web to verify the accuracy of your provider records or collect required data. Keep your provider files updated at a fraction of the cost of doing it yourself.

Targeted solutions

NPI integrator

Submit your provider data file and Optum will fill in missing National Provider Identifiers (NPIs) and then compare/correct the NPIs you submit for each provider. Or we can send you a file of all providers with their NPIs and other key identifiers (UPIN, DEA Number, State License, etc.) from our Provider360 Database, allowing you to easily match our data to your in house provider database. Our NPI data is sourced solely from the federal National Plan & Provider Enumeration System (NPPES), so you can be assured of accurate data directly from the enumerating source.

Medicare opt-out locator

You need to maintain a Medicare-compliant provider network. But obtaining opt-out status from the many disparate Medicare Administrative Contactor (MAC) sites is time consuming; and matching that data to your in-house provider file can be challenging. Optum can help you continuously monitor your providers’ opt-out status by matching your file to our Medicare opt-out database compiled quarterly from each CMS contracted Medicare MAC site.

Sanctioned provider locator

You don’t want sanctioned providers in your network, and you don’t want to pay them. Optum will identify sanctioned providers in your file based on our comprehensive sanction database compiled monthly from more than 400 state licensure boards, state Medicaid agencies, the federal Office of Inspector General, and General Services Administration. Optum then provides you with detailed sanction information for each identified provider. We will deliver current and historical sanction data, show if the provider’s license or privileges were revoked and the date reinstated, and flag if the sanction was due to monetary fraud/abuse.

Deceased provider locator

Deceased providers are a prime target for fraud. And it can reflect poorly on your operation if you list them as part of your active network. Optum matches our Provider360 Database each month to the Social Security Administration’s Death Master File to identify providers that have deceased. In turn, we can identify deceased providers in your file, flag them and provide you with their date of death.

Best address locator

Up to one-third of all correspondence to providers is returned because of address errors, which is a source of frustration to both parties. Optum will provide you with the best delivery-point-verified address for each provider in your file to ensure your mailings are accurate and cost effective. This not only helps to reduce your return mail rates, but can also eliminate duplicate mailings and build stronger provider relations.

Custom solutions

Optum can work with your organization to accommodate almost any provider data need. Contact Optum if you need help with provider matching, data integration with your in-house systems, data alignment across multiple provider databases and more.