Provider Network Data Management
Our provider network data management process mitigates increased labor costs due to the enhanced complexity of provider payment arrangements and provider network contracts. By streamlining processes, our provider credentialing services efficiently avoid incorrect contract rates in claims to reduce hassle and prevent administrative burden. These services are all aimed to help payer organizations streamline the way that they operative, providing a positive impact across the various business lines.
1. Provider Data Management
Our revolutionary provider data management solutions help to streamline the way you do business, resulting in enhanced data accuracy and reduced operational costs.
KKS Tech Solutions’ provider data management solutions make it easy for healthcare organizations to manage provider data so they can boost the success of strategic patient access initiatives. Our revolutionary provider data management solutions result in more accurate data and reduced operational costs. We have a vast amount of experience in provider data management initiatives for large preferred provider organization (PPO) networks and numerous third-party administrators (TPAs).
We specialize our solutions across:
- Contracting (provider build/setup and provider maintenance)
- Credentialing and recredentialing
- Managing provider information on claims
KKS Tech Solutions’ team of experts review, assess, and execute a project plan for provider records, including contract and demographic information.Below is a list just a few of the processes we cover for provider maintenance/build:
- Verifying the required data elements of each provider/group’s request’s receipt and matching these to the existing database
- Creating new records if the provider listed in a claim is not present in the client’s database
- Locating missing information, such as specialty and category, using the National Provider Identifier database
- Authenticating W9 forms received from providers and making any necessary updates in our clients’ systems
2. Credentialing
Providing a host of hybrid and versatile solutions for credentialing services that improve quality, accuracy, and speed of provider data collection while continuously alerting clients to any changes in healthcare provider data points.
KKS Tech Solutions provides a host of hybrid and versatile solutions for credentialing services. Our team expertly handles payer enrollment and contracting for our clients, turning an arduous task into a quick and easy process. Our credentialing and recredentialing solutions improve quality, accuracy, and speed of provider data collection while continuously alerting clients to any changes in healthcare provider data points, such as infractions or sanctions. We uphold the highest standards of compliance with our centralized credentialing, so your organization never has to worry. Our credentialing and recredentialing solutions include:
Data Lift and Abstraction:
Providers must submit enrollment applications and re-enrollment applications to health plans on a regular basis. These application forms then need to be added to or updated in the client’s system. Revolutionizing a once manual process, KKS Tech Solutions performs data abstraction and data lifts from these applications for our clients. Any missing information is reported back to the client for further action. Data points measured with our data lift services include:
- Provider information (name, SSN, address, NPI, etc.)
- Tax ID
- Education certificates
- CME certificates/credits
- Health-related documents:
- Health assessments
- Drug tests
- Immunization and titers
- Copies of PPD tests
- If the test is negative, we request another test result on a yearly basis
- If the test is positive, we request a chest X-ray copy and a yearly positive PPD questionnaire
Information Verification:
For our credentialing services, we provide the highest quality of information verification. The information we verify includes:
- Personal info/demographics, including SSN, address, and phone number
- NPI, specialty, etc.
- Education: medical school, internships, residency, fellowships, etc.
- Licenses
- State licenses
- DEA verification
- Controlled substance registration (CSR)
- Board certifications
- Specialty-related certifications
- Malpractice history
- References/affiliations/work history
- CAQH verification