Almost Everyone Touches It, But Almost No One Shares It

Provider eligibility data is an enterprise-wide responsibility, but the enterprise is siloed.

Ask any healthcare executive which departments interact with provider eligibility data, and you'll get a long list. In our survey, 90% of organizations reported that the departments that interact with provider eligibility data are:

Data Governance topped the list at

Credentialing and IT followed at

Human Resources was cited by

of respondents

Compliance was cited by

of respondents

Billing and Finance followed at

More than two-thirds of healthcare executives surveyed also reported that provider network operations/management (73%) and contracting departments (67%) interact with provider eligibility data.

What’s notable is not only the use of data across multiple departments but also the way most organizations manage it. Only 13% of organizations have all departments sharing the same data. Another 47% share data across most departments, while 40% share data only in some departments.

Simply said, most healthcare organizations are running on fragmented provider eligibility data. Different departments have different data and rely on different versions of the truth.

“Fragmented processes and systems reduce our confidence in data accuracy.”

—Survey respondent

The data sources that organizations rely on are well-established. The NPPES NPI Registry and State Licensing Boards are used by 98% of respondents. The American Board of Medical Specialties (ABMS) is at 97%. The National Committee for Quality Assurance (NCQA) and The Council for Affordable Quality Healthcare (CAQH) round out the top five at 91% and 90%, respectively.

These are trusted, established sources, but the pipelines connecting them to the departments that need them are inconsistent at best and often require manual processes or reconciliation. Having the right sources doesn't solve the distribution problem. It just means the raw material is there and waiting to be put to work.