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MCheck™ Provider

An end-to-end provider data management solution

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Standalone solutions

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Roster ingestion

We ingest rosters in any format, standardize them to meet your needs, and apply plan-specific business logic regarding network and pricing.

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Directory maintenance

We integrate with your system to automate provider directory updates and maintenance.

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Directory accuracy

We use thousands of sources to score your provider directory accuracy and suggest updates.

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Provider data sourcing

We augment your directory with multidimensional provider information, such as demographics, images, and affiliations, to provide a complete picture of your providers.

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Database migration

We simplify and automate migration of provider directory databases to meet your data infrastructure needs.

Overview

Provider data accuracy is an ongoing, industry-wide challenge. Inaccurate provider directory data heavily impacts the member experience and can lead to surprise billing or poor access to care. Poor quality provider data also co... Show More

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Features

Comprehensive
Rapid deployment
Adaptive intelligence
Seamless integration

Our one-of-a-kind R 3 approach (recency, relevancy, reliability) creates the source of truth for provider data utilizing 1000s of external sources, health plan internal data, and out-of-the-box business rules. These three components produce actionable recommendations across critical provider data elements that are 95%+ accurate in production.

Value for customers

    Operational cost savings

    Our automated ingestion process allows over 90% of directory updates to be processed without manual intervention.

    Timely directory updates

    MCheck™ Provider can process rosters within minutes, meeting the needs of members, providers, and regulators.

    Seamless integration into existing systems

    MCheck™ Provider can seamlessly integrate into specific aspects of your provider data workflow or serve as a comprehensive end-to-end provider data solution.

    Configurations to exhaustively cover business logic requirements

    MCheck™ Provider has configurable sources, source weights, and recommendation thresholds, allowing plans to set their own risk tolerance regarding data updates. The product also comes with out-of-the-box business rules to safeguard against more risky provider data updates (e.g. terming or suppressing the only location for a PCP).

    Customizable solutions to meet compliance requirements

    In some cases, health plans are limited by compliance/regulations and cannot always remove bad data from the view of their members. Our product can adjust its algorithms and recommendations to ensure that plans always stay in compliance.

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Approach

MCheck™ Provider ingests provider data/rosters in all formats (structured and unstructured). It then normalizes and standardizes this data to be compatible with your downstream systems. It can be configured to only identify and process updates to existing provider data instead of processing every entry as entirely new. MCheck™ Provider also integrates with health plan internal systems to perform auto updates to the provider directory databases and propagate that data to downstream systems.

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Try our solution today