LA Care Health is the nation’s largest public health insurance entity with close to $10B annual spend taking care of 12M members with 10K providers. Apart from the timely and accurate provider network adequacy reporting to regulatory bodies and healthcare agencies there was a strong need to validate provider credentials/facilities and support accurate member assignments.
THE CHALLENGE
Poor quality provider data lead to high operational costs and poor standards of service that was delivered to members. Being in the healthcare delivery space, this could not only cost the company financially but also damage their reputation and credibility.
  • Ensure members are able to receive care from various hospitals, practitioners and ancillary provider types based on regulatory parameters through complete visibility of the provider network and their associations.
  • Submit provider network adequacy and other provider-related data to regulatory and accreditation agencies to ensure LAC is compliant. Certify providers (18+ certifications) with a streamlined credentialing workflow.
  • Conduct manually intensive facility site reviews for various provider facilities on different periodic schedules with active tracking of review assignment, corrective action plans (CAP), scores and status.
THE DT ADVANTAGE
Our approach involved the creation of a seamless digital experience all the way from certifying provider records to credentialing workflows and facility site reviews.
  • Automation of attested provider data and their relationships with IPAs, Hospitals and ancillaries, in line with data quality regulations, credentialing, FSR and contracting
  • Standardization of provider profiles, with certified records in the master data repository, representing provider credentials and FSRs (facility site reviews)
  • Provider facility review digital dashboard with visibility into the past, current and upcoming reviews, driving timely review processes
  • A mobile platform that allowed nurse practitioners to capture facility reviews, PARs and medical records data which integrated with MDM, on-the-go
Our approach involved the creation of a seamless digital experience all the way from certifying provider records to credentialing workflows and facility site reviews.