Provider Data Quality Mass Update Tool

This data gateway tool prevents the ingestion of corrupted or duplicated data, which then improves the data-consumption experience for both members and prospects

Challenge

Our client recognized poor Provider Data Quality (PDQ) as the root issue for inaccurate provider directories and problems with processing claims – which was significantly impacting their brand. The client wanted to improve the quality of the existing data set, so they purchased a new Provider Information Management System (PIMS) from McKesson – but they encountered multiple implementation issues.

For example, its mass data update component had limitations and was unable to run custom business rules.

In order to use McKesson services, our client wasn’t able to directly touch/meddle with the system’s database, so they bought a solution from another vendor that was supposed to fix these issues. The solution wasn’t working and time was ticking.

Our client needed a system that would consume and update data from various sources and then process them in a predetermined fashion, so they decided to have one custom-built.

Provider Data Quality Mass Update Tool

Solution

Within a very aggressive timeline, Vicert created the PDQ Tool a.k.a. MUT (Mass Update Tool), built as a data gateway that prevents the ingestion of corrupted or duplicated data from third-party systems.

The tool enables:

  • Ingesting external data from 9 different sources (such as IPA Roster/Large Group PPO Roster, Death Index, Existing Provider New Network, etc)
  • Applying configurable business rules
  • Comparing the data against the live PIMS data, allowing either automatic or manual updates of that data in the PIMS system

 

The PIMS updates are made in two ways.

(1) For the automatic updates, the PDQ tool first inserts data into the PIMS stating tables, and then uses PIMS’ PDX Update feature to trigger data processing.

(2) For the manual updates, a new web service was created to perform real-time updates to PIMS data.

Vicert implemented the process for the providers’ data collection, merged this content with the client’s existing data structure, and finally, implemented an appropriate presentation layer to allow content browsing.

Our tool also provided reporting capabilities on the volumes, data trends, and timelines.

benefits

With this custom solution, our client was able to enhance the member and prospect experience when consuming provider data. Additionally, the client was also able to respond to the California Department of Managed Health Care’s expectation for more timely data validation.

The client initially started working with another vendor, but switched to us since they could not afford to have delays.

We were able to deploy the solution in 9 months, which means it was delivered in less than 40% of the time initially allocated for the project.

Overall, the use of this tool allowed almost complete workflow automation, resulting in substantial resource savings on the client side (more than 10,000 working hours saved).