Though data drives the modern healthcare industry, many organizations operate with stale or inaccurate data due to a lack of support, time, and attention to devote to a data overhaul. ProviderTrust aims to build a data-driven partnership with each client, working to achieve and maintain data integrity with the ultimate goal of delivering reliable results for a safer healthcare system.
This case study examines how ProviderTrust developed a data-focused partnership with a leading enterprise health system, collaborating with our client to eliminate duplicative efforts and reach organization-wide data integrity as they transitioned exclusion monitoring services from a less-accurate vendor to ProviderTrust’s leading solution.
active vendors
employees
providers
providers in-network
referring and ordering physicians
ABOUT OUR CLIENT
Our client is a prominent private healthcare organization that serves millions of patients each year in hospitals and care sites nationwide. Since 2022, this client has partnered with ProviderTrust for ongoing automated federal and state exclusion monitoring of more than 300,000 individuals and entities. This population encompasses the client’s employees, vendors, providers, and referring and ordering physicians.
active vendors
employees
providers
providers in-network
referring and ordering physicians
ABOUT OUR CLIENT
Our client is a prominent private healthcare organization that serves millions of patients each year in hospitals and care sites nationwide. Since 2022, this client has partnered with ProviderTrust for ongoing automated federal and state exclusion monitoring of more than 300,000 individuals and entities. This population encompasses the client’s employees, vendors, providers, and referring and ordering physicians.
active vendors
employees
providers
providers in-network
referring and ordering physicians
THE CHALLENGE
As an enterprise health system with care sites across the country, this client required exclusion monitoring for an ever-expanding population of employees, providers, and vendors. For years, the client worked with a low-cost legacy vendor. However, as the health system expanded, this low-cost vendor was unable to scale with the organization’s evolving data needs.
Our client’s organization had grown so vast that varying regional markets within the health system had developed their own processes for exclusion monitoring—down to crucial details like where data streams originated and which populations should be monitored. The corporate compliance team knew they needed to standardize the process across the organization, but the volume of inconsistencies made this a monumental challenge.
Our client needed a strong, experienced partner to dig into the problem and build a reliable approach to federal and state exclusion monitoring from the ground up. Enter ProviderTrust.
"We’re a large organization. There’s been a lot of people touching this process over the years. It wasn’t standardized, it wasn’t centralized, and we had very poor historical information. We knew we had issues with our prior vendor—their accuracy was lacking,” said the client’s national compliance officer for acute care.
As an enterprise health system with care sites across the country, this client required exclusion monitoring for an ever-expanding population of employees, providers, and vendors. For years, the client worked with a low-cost legacy vendor. However, as the health system expanded, this low-cost vendor was unable to scale with the organization’s evolving data needs.
Our client’s organization had grown so vast that varying regional markets within the health system had developed their own processes for exclusion monitoring—down to crucial details like where data streams originated and which populations should be monitored. The corporate compliance team knew they needed to standardize the process across the organization, but the volume of inconsistencies made this a monumental challenge.
Our client needed a strong, experienced partner to dig into the problem and build a reliable approach to federal and state exclusion monitoring from the ground up. Enter ProviderTrust.
"We’re a large organization. There’s been a lot of people touching this process over the years. It wasn’t standardized, it wasn’t centralized, and we had very poor historical information. We knew we had issues with our prior vendor—their accuracy was lacking,” said the client’s national compliance officer for acute care.
ProviderTrust stepped up to become a true data partner for this client, pulling from more than a decade of experience with automated exclusion monitoring for organizations of all sizes. Given the client’s known data disparities and vast population, our internal data experts partnered with the client to improve their data management processes and ensure a smooth transition to ProviderTrust’s solution.
The ProviderTrust team worked with our client to identify gaps in their approach across the health system and consolidate duplicate data. In the vendor segment alone, our client cut their monitored population by more than half—from about 180,000 to about 70,000—in the process of identifying and removing inactive and/or duplicative vendors.
After a few months of working closely to optimize the client’s data and establish organization-wide standards, our client achieved ongoing exclusion monitoring for their entire population—a process that likely would’ve taken more than a year without data management support from ProviderTrust.
Today, our client has full oversight of more than 300,000 employees, providers, ordering and referring physicians, and contingent workers, with a noteworthy increase in accuracy compared to their prior vendor. A centralized source of automated, ongoing exclusion monitoring has freed up their compliance resources to focus on the bigger picture instead of sorting through stale data and potential matches. And with active data maintenance and support from ProviderTrust, this client has a lasting data partner to ensure timely, accurate results.
THE RESULTS
Upon implementation, ProviderTrust uncovered 31 excluded individuals from eight different sources, including state-level Medicaid exclusion lists. The vast majority of these exclusions—81%—were identified using ProviderTrust’s proprietary data strategy and would have been missed by other vendors. We also identified 115 NPI-related issues, including NPIs that were inactive, invalid, or simply not found.
A partnership with ProviderTrust has empowered our client to:
Trust in the accuracy of their results
Optimize organization-wide data management processes
Achieve full compliance oversight into exclusion monitoring practices
Establish a standardized process for federal and state exclusion monitoring
Identify duplicate data and eliminate unnecessary costs
Optimize organization-wide data management processes
Achieve full compliance oversight into exclusion monitoring practices
Trust in the accuracy of their results
Identify duplicate data and eliminate unnecessary costs
Establish a standardized process for federal and state exclusion monitoring
THE FUTURE
Now that our client has strengthened their data integrity and gained a centralized source of ongoing exclusion monitoring, their compliance resources can be reallocated to other high-priority initiatives.
Reflecting on their remarkable progress, our client says that the process wasn’t always easy, but the results have been impactful. Their compliance officer’s advice to other organizations in need of a data overhaul? Ask questions and prepare for a complex process, but when it comes to choosing ProviderTrust, “I would have no hesitation.”
THE FUTURE
Now that our client has strengthened their data integrity and gained a centralized source of ongoing exclusion monitoring, their compliance resources can be reallocated to other high-priority initiatives.
Reflecting on their remarkable progress, our client says that the process wasn’t always easy, but the results have been impactful. Their compliance officer’s advice to other organizations in need of a data overhaul? Ask questions and prepare for a complex process, but when it comes to choosing ProviderTrust, “I would have no hesitation.”
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