Case Study
MedCost Builds an MDM Foundation of Provider Data Management with Coperor
MedCost is a leading self-funded health benefits administrator. Serving over 700 employers throughout the Carolinas and Virginia, including 47 hospitals. MedCost helps companies balance the care of their employees with the financial health of the company. Their integrated clinical programs combine member care with effective claims management.
The Challenge
MedCost had the daunting challenge of migrating data from legacy claims and credentialing systems into a modern provider data management system so they could unlock the value from their newly deployed HealthEdge HealthRules Payor solution.
MedCost’s goal was to centralize claims data into a single payment system to automate processing and improve claims adjudication rates.
The Solution
The MedCost executive team selected Gaine’s Coperor Health Data Management Platform (HDMP) to improve data quality and manage ongoing enrichment and cross- application interoperability.
Efficient, centralized architecture and customizability to meet MedCost’s operational needs were a requirement. Ensuring quality of data to maximize the value of the HealthEdge HealthRules Payor investment was also critical.
Conclusion
Multiple advanced integration options
With Gaine's Coperor Health Data Management Platform (HDMP), MedCost created a single, highly adaptable extract of provider data from multiple data sources. The technology also needed to meet MedCost’s future needs for API-based connectivity.
Parallel System Support
It was necessary for MedCost to continue using some of their legacy technology, so it was imperative that the solution keep these systems up to date as well. Coperor ensures that updates are synced enterprise wide.
Furthermore, once HealthEdge HealthRules Payor solution is integrated, it was necessary for new records and updates to occur in real-time across critical systems. Coperor empowers organizations to enable bi-directional syncing rapidly and dependably.
Quantifiable Benefits
- Over 30% de-duplication of provider data
- Over 40% improvement to provider address information
- Improved leased network management information
- Updated billing information on providers from credentialing systems
Future Opportunities
- Member Data Mastering
- Advanced Reporting and Data Analytics
- Streamlined integration of additional provider sources
Coperor Health Data Management Platform
Coperor consolidates and maintains accurate provider data across an ecosystem. Data completeness and quality improves its usability and reliability and enhances any internal or third-party data enrichment processes. Coperor gives Third Party Administrators and Health Plans the best possible auto-adjudication rates by correcting and standardizing member and provider data between claims data and core administration systems.
To learn more about this success story and Coperor, schedule a quick introductory discussion with a team member.
