Product Overview

FETCH PROVIDERS FROM EXTERNAL SOURCES

Easily Onboard providers from external systems such as NPPES and CAQH to expedite provider onboarding/enrollment

Ready-to-use integration to obtain Provider data by leveraging Third Party services such as NPPES and CAQH with the Fetch Provider module

• Utilizes data-sharing API to fetch Provider data from NPPES and CAQH

• Seamless workflow to enable Provider Sign Up process to kick start enrollment and obtain information from CAQH

• Automates Provider data entry through obtained data

• Automated process to request CAQH to add Provider in the CAQH Roster

• Apply business rules to ensure the acquisition of cleaner and consistent data

• Calling APIs to consume data from external interfaces for data nurturing, cleansing, and standardization

• Real-time address address validation with third parties to standardize Provider addresses

• Expedited Provider Recruitment with multi-point initiation and process transparency
• Reduced Application Processing Time, Improved Provider Satisfaction, and Increased Operational Excellence
• Automatically generate pre-populated state-specific application forms
• Provide real-time credentialing application status updates
• Move Providers into different sub-stages to complete the overall recruitment/onboarding workflow
  • Open
  • Contacted
  • Qualified
  • Unqualified
  • Inactive
  • Rejected
  • Not Interested
  • Member Nomination
  • Verbal Commitment
  • Looking Over Paperwork
  • Missing Paperwork
  • Contract Received
• Notify key stakeholders at every step of the process

• Move Provider into different sub-stages (configurable) to complete the overall data entry
  and review workflow
  • Data Collection
  • Manual Review
  • Additional Information Requested
  • Information Not Received
  • Data Entry Completed
• Notify key stakeholders at every step of the process

• Run credentialing verification either in-house or through external CVO through a unified and seamless process
• Seamless integration to primary credentialing sources to get required Provider data for verification purpose
• Automatically redirects credentialing specialists to different primary source verification websites
• "Virtual Committee" capability to allow committee members to securely access Provider files
• Automates generation of approval and denial letters/emails to Providers
• Enable Providers to appeal against any credentialing decision improving Provider satisfaction
• Achieve actionable real-time insight and transparency into Credentialing Pipelines
• Intuitive widgets to show critical Credentialing timelines
  • Provider creation date
  • Provider submission date for data entry
  • Date when an application was signed
  • Date when the final completed application was received from the Provider
  • Date Provider was sent to committee.
  • Committee approval/decline dates credentialing start date, end date, etc.) related to Provider credentialing process.
• Move Provider into different sub-stages to complete the overall verification workflow
  • In-house Credentialing Verification
  • Additional Follow up Needed
  • No Response
  • Ready for CVO
  • Sent to CVO
  • Received from CVO - Complete and Clean
  • Received from CVO - Complete and Non-Clean
  • Received from CVO – Incomplete
  • Credentialing Verification Completed
• Automated building of Re-cred Provider list to initiate the re-credentialing process
• Notify key stakeholders at every step of the process

• Manage/Support entire contract lifecycle and create a standard contract template based on State, Specialty, and Network
• Easy contract management with user-intuitive review and e-signature feature for Providers
• Assign Providers and TIN to existing contract and fee schedule

• Complete Credentialing Profile and mandatory documents to start the onboarding process
• Electronically sign the application and jump-start the Credentialing and Contracting process

• Manage numerous Tax IDs and related Providers
• Submit maintenance requests to add a new location, license, or specialty
• Track expiring credentials for different Providers
• Manage Practice addresses and contacts for address types
  • Office Location
  • Billing Location
  • Mailing Location
  • Tax Address
• Manage critical information related to the Practice
  • Other IDs
  • Site Services
  • DBA names
  • Type 2 NPIs
  • Account Details
  • Previous Owner Details
• View network assignments and fee schedules along with effective and term dates for different associated Providers
• View all the attached fee schedules that apply to the respective Tax ID

• Authorized users can approve or decline the changes requested by external users such as Provider (or their Payer staff) and internal users such as new trainees, recruits, etc.

• Automates and simplifies processing and maintenance of roster files
• Create and apply different data priming and operational business rules to effectively massage/nurture the incoming data (as per business needs)
• Produces comprehensive Process and ETL logs showing records count (total records, success, and failed) and reports actual rejected records along with applicable reasons for rejection
• Automatically run the file imports on a pre-defined schedule as set by the user
• Define and leverage crosswalks to maintain a unified master reference for specialties, languages, etc.

• Bulk extract Provider data into multiple formats (such as CSV, fixed-width, etc. as needed by the downstream systems
• Create and apply different data priming and operational business rules to effectively massage/nurture the outgoing data (as per business needs)
• Automatically run the file imports on a pre-defined schedule as set by the user
• Define and leverage crosswalks to produce specific master reference as desired by different downstream systems
• Extract different kinds of file types - Full, Add, Change, and Term
• Apply different file level filters to effectively massage/nurture the outgoing data (as per business needs)
• Identify different types of exclusion
  • CMS Medicare
  • State Medicaid
  • Payor-specific and more

and apply specific rules to either send or exclude them as required by different downstream systems.

• Call external APIs to fetch data and consume within I-Network
  • eSign Genie – for getting provider’s electronic signature
  • NPDB – for getting provider’s malpractice information
  • NPPES – for getting provider’s NPI validated and related information
  • Pitney Bowes – for getting provider’s address validated and scrubbed
  • CAQH – for getting provider’s credentialing information

• • Add/Update Provider
    • This API can be used by any external entity (authenticated with Santech) to post an “Add Provider” request into I-Network by sending pre-defined critical parameters required by I-Network to add/update a provider successfully
• • Lookup Provider
    • This API can be used by any external entity (authenticated with Santech) to post a “Provider Look Up” request into I-Network by sending specific search parameters required by I-Network to filter all the matching providers

PROVIDER COMMUNICATION

Comprehensive Provider outreach capabilities to improve Payer-Provider relationship with efficient communication

I-Network has an all-encompassing Provider communication outreach module where letters and e-mail templates can be designed and applied for outreach purposes for different events.

• Build notifications as per your parameters to remind Providers of upcoming processes
• Generate communication like eFax, letters, and emails notifications to alert Providers
• Track correspondences, outcomes/results, and sent documents
• Track Provider responses and ensure they’re done timely
• Send Provider notifications for renewing credentials - Ability to send and track communications during Provider credentialing and re-credentialing stages at various triggered events like when Providers are due, submits application, committee approvals or denials etc.
• Track history of all communications with Provider for a quick review for Providers and Provider relationship staff
• Allow the business user to create and configure communication templates and store them for event based triggering

PROVIDER EXPIRY MANAGEMENT

View, Filter and Proactively Generate Expiry Provider Notifications to Alert Payors and Providers to Update Provider Data

• Integrated Provider communication/notification feature to alert and send requests to Payors & Providers
• View and send expiry Provider notifications as per expiry type such as license expiry notification, board expiry notification, CME credit expiry notification etc.

1. ROLE-BASED ACCESS

Secure web-based access for users across organization and external stakeholders by assigning pre-defined user roles with access privileges

• View/manage/create multiple users
• Efficiently assign the user to appropriate functional roles with set privileges/permissions (such as view only, modify, etc.)
• Efficiently assign a specific block of business to users so that their data access can be controlled and focused on the relevant data set that matters to them

2. I-AUDIT

Keeps track of all Provider data changes & identify them instantly

• View an audit trail of changes made in the system on a specific record such as who made the change, when the change was made, what change was made, and source of change/information
• View user login/logout activities
• Show provider data audit history showing all the deletions, who made it and when it was made

3. PROVIDER SEARCH

Enhanced Provider Inquiry Capabilities

• Advanced search capabilities to look up providers using multiple parameters
  • Name
  • Specialty
  • Network
  • License
  • License state
  • practicing location state and more

1. NETWORK DISRUPTION

Compare Provider data across multiple networks to determine the matching and distinct Providers within specific networks

• Deciding on the right network leasing partner: if a Payer or network is considering lease an external network to expand their Provider base within a particular region, then the "Disruption" module can help them
• Leverage multiple pre-loaded match configurations to disrupt the data across various networks created using full/partial values of different parameters
  • First Name
  • Last Name
  • NPI
  • SSN
  • DOB
  • Title
  • Specialty
  • License
  • Other ID (different ID Types)
  • Tax ID
  • Address 1
  • Address 2
  • City
  • State
  • Zip
  • Location Phone
  • Location Fax
• Create multiple disruption files, each having different match configurations to allow users to compare the match results based on numerous different matching sequence
• Extract the disruption output in CSV format

2. NETWORK STACKING

Stack the data of multiple networks for consumers to get more Providers with desired rates as per the network priority ranking setup by them

• Users can choose from different pre-loaded match configurations to get a desired stacked output
• Users can configure the stacking layout and define different formats (such as CSV, fixed-width, etc.) in which they would like the stacking output
• Extract different kinds of file types –Stacking Full and Stacking Change
• Flexibility in assigning network priority ranking