Quality Provider Data Directly Impacts Your Claims Adjudication Rates
Customer Story
MedCost Builds an MDM Foundation of Provider Data Management with Coperor One Provider
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 One Provider 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
Gaine utilized its Provider Data Management solution, Coperor One Provider, to create a single, highly adaptable extract 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 provider data management 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. Gaine’s Coperor Transformation Adaptor 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 One Provider
One Provider 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 One Provider combines with Coperor One Member to give 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.
