Provider information management

Provider information management that verifies provider data and powers search

Optum provider information management supplies standardized provider data for all qualified health plans (QHPs), enabling consumers purchasing insurance through the health insurance marketplace to easily compare provider network options and choose a health plan.

Our provider information management uses more than 600 data sources to match, validate and update the provider data for all participating QHPs. Rigorous format validation, standardization and integrity checks are part of the process. Optum works with the QHPs to address inaccurate or incomplete data, ultimately collapsing the data into one comprehensive file. These consolidated and standardized data files power the search tool on the health insurance marketplace website.

Optum provider information management (PIM) provides immediate benefits for the health insurance marketplaces through:

  • Positive shopping experience. PIM powers the health insurance marketplace with updated, verified and standardized provider data, which consumers can use to compare health plans, locate their preferred physicians and choose the plan that will serve them best. Speed, accuracy and ease of use promote customer satisfaction and retention.
  • Reduced operating costs. Inaccurate provider data are estimated to cost the health care industry $26 billion every year (Thomson Gale Publications 2007). Consolidating data validation for all QHPs through the health insurance marketplace reduces the duplicative cost of each plan doing the work on its own, benefitting all participants.
  • Lowered risk of fraud, waste and abuse. Inaccurate provider information increases the risk of fraud and abuse. PIM helps minimize vulnerabilities by enhancing data accuracy and maintaining timely provider sanction data.

All stakeholders benefit from the complete and verified provider data PIM provides:

  • State agencies can improve provider screening, monitor sanctions, analyze network adequacy, improve compliance reporting, monitor quality and gauge consumer satisfaction.
  • Providers can streamline the reporting of their practice information, reducing duplication of administrative tasks.
  • All payer claims databases can provide quality and cost reporting, conduct care pattern analysis, identify practice improvements and perform financial analysis.
  • Health information marketplaces can supply updated provider information to health information exchanges (HIE) to help streamline and reduce administrative costs in clinical data sharing.

Rigorous security maintains confidentiality

The PIM processing model maintains the highest levels of security through multi-level protocols and authorizations. All proprietary payer data is segregated via logical multi-tenant database design.

Contact us today to learn how Optum can manage your QHP provider network data.