Our Technologies / ProviderIQ™

ProviderIQ™
The Most Innovative Credentials Verification Platform

ProviderIQ™
Solves Key Challenges in Healthcare Data

 Compliance and Litigation Risks

Inaccurate provider data may cause monetary penalties. ProviderIQ™ is a new approach to managing provider directories and other provider data requirements that help meet federal and state compliance guidelines.

 Provider/Member Dissatisfaction

Providers are not correctly matched to products/plans. ProviderIQ™ accurately matches providers to the right products and plans. As a result, members no longer have trouble finding in-network providers.

 Disparate Systems

Most organizations have multiple databases that are not connected (credentialing, claims, provider data, etc.) and do not easily share data. This complexity adds more risk to the data verifications process. ProviderIQ™ is the first solution that automates the provider verifications process and centralizes accurate provider data in one system.

 Provider Data Changes Rapidly

At any given time, approximately 40% of provider records are inaccurate and outdated. Our web-based technology and class-leading outreach team enables us to capture internal client data, self-reported data (CAQH or other electronic applications), and to verify and continuously monitor that information against primary and secondary data sources.

ProviderIQ™ is a suite of applications that enable healthcare organizations to power their provider data processes efficiently with accurate data.

Network Enrollment Solution

Medversant’s Network Enrollment Solution streamlines the entire provider enrollment process between health plans, fiscal intermediaries, and providers.
  • Expedites the enrollment process
  • Contract upload and digital signature attestation
  • Manages an unlimited number of applications
  • Approval workflow
  • Provider pre-screen capabilities

Primary Source Credentialing Solution

To date, more than 4.2 million providers have been credentialed or screened by Medversant's patented technology. With increasing compliance and litigation risks, it is important to have a partner that has the experience and knowledge to solve the most complex credentialing challenges.
  • The first dynamic electronic application that captures data from all provider types
  • Can be pre-populated from CAQH or your health plan's database
  • Streamlined provider outreach and support to minimize non-responders
  • Patented verification technology automates data capture from primary sources with corresponding date-stamped images
  • Continuously queries state and federal databases for sanctions and disciplinary actions
  • Transparent client interface allows heath plans to track file status


Virtual Review Committee (VRC) Solution

The Virtual Review Committee Solution is a web-based application that facilitates peer review meetings by providing the tools and the information necessary to render and document committee decisions.
  • Conveniently allows members to remotely participate in real-time peer review meetings
  • Paperless access to the providers' profiles including full supporting documentation
  • Administrators can assign peer members to cases accordingly
  • Multiple user permission levels to control user access
  • Annotate, exchange information, vote, and record the entire process
  • Generate meeting reports

Network Adequacy Solution

Medversant's Network Adequacy Solution is based on a geocoding/mapping system that identifies the underserved members population by location, ensuring that health plans meet network adequacy standards on the federal and state level. According to the 2017 final rule, the government plans to evaluate networks based on the number and specialty of providers and their location in comparison to covered enrollees to define a time and distance standard at the county level, in order to provide better access to underserved populations. Included in the proposal, CMS wants plans in the federal exchange to include a rating of each qualified health plan's relative network coverage based on the coverage of other plan networks available in the geographic area.
  • Interface captures each state’s MCO requirements
    - By distance
    - By travel time
    - By provider type
  • Geocodes patient addresses and provider locations
  • Generates reports for underserved patients
  • Suggest pre-screened providers to reduce/eliminate network gaps
  • Ensures compliance with state and federal network adequacy standards
The network adequacy solution is currently in beta testing, scheduled to fully launch in Q1 2017.


Provider Directory Solution

The industry’s first solution that does more than just feed self-reported data into your provider directory. ProviderIQ™ captures both external provider updates and internal data, which is then verified, maintained, and pushed back into your provider directory, ensuring you always have the most accurate and comprehensive provider data.
  • Real-time provider directory updates
  • Verifies provider data against primary and secondary data sources
  • Meets state and federal provider directory compliance standards, such as CFR 422.111(b)(3)(i) and 422.112 (a)(1)
  • Includes a co-branded interface where providers can update their information: demographic, specialty, affiliations, languages spoken and other requirements
  • Matches products/plans to the appropriate provider
  • Pre-populates data from CAQH or from your internal databases
  • Increases member and provider satisfaction
  • Rapid implementation

Non-Responder Solution

The Medversant Non-Responder Solution utilizes our patented technology in combination with our U.S based provider outreach staff; which enables us to significantly reduce your non-responder rate.
  • Mitigates non-responder rates
  • Timely non-responder roster sent to insurer for internal decision escalation
  • Outreach attempts are recorded and time-stamped for audit purposes
  • Meets federal and state compliance regarding quarterly communications



Claims Screening Solution

Medversant’s Claims Screening Solution ensures that claims are submitted by qualified providers who are licensed and without sanctions. ClaimGard™ works by providing verified provider information to the claim process based on a date of service or date of payment.
  • Corrects claim information prior to payment
  • Identifies fraud and supplements claims with missing information
  • Specify rules for automatic flagging of potential fraud
  • Integrates with any current fraud detection process/system
  • Dynamic reporting capabilities



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