Our Products

MCheck™ Provider

An end-to-end solution for improving provider data accuracy

Overview

The accuracy of provider data is an ongoing, industry-wide challenge. It has been estimated that almost 50% of provider directory entries are inaccurate. Not only is this problem widespread, but it also heavily impacts the member experience and can lead to surprise billing or poor access to care. In addition to the member experience, poor quality provider data costs organizations upwards of a staggering $2B a year, impacting operational efficiency, profits, quality of care, and patient outcomes. Many of these costs are borne internally by the health plan and stem from downstream impacts of poor provider data including member and provider dissatisfaction, claims impact (overpayment) and compliance penalties.

While some of these accuracy issues are due to reconciliation issues between plans and providers, most are a result of simple human error. Large health plans typically receive thousands of provider directory updates every single day. These updates come in many, disparate formats, from highly complex and sophisticated provider rosters to ad-hoc, phone calls, e-mails, and even faxes. With so many updates, formats, and no clear source of truth, it is not surprising that provider data is riddled with errors.

Our team of engineers and data scientists have developed a fully automated, scalable solution to vastly improve provider data accuracy and operations for health plans. Our solution has improved simulated CMS style audits in excess of 25% and also allows plans to automate provider data updates to meet the upcoming “48-hour rule” that is part of CAA compliance.

Testimonials
MCheck: Provider increased our directory score by over 29%. We could never have done that without MCheck’s recommendations and integration.
Director, Provider Data Quality and Automation One of the Largest Health Plans in the United States
Approach

MCheck™ Provider ingests provider data/rosters in all formats (structured and unstructured). It 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 as opposed to 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.

MCheck™ Provider comes with out-of-the-box business rules to maximize value and minimize risk for health plans, but also allows for market and line of business-specific configurations. Although the product has achieved tremendous results, we are continuously improving our core product by enhancing its capabilities.

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Features
Comprehensive set of rules based on business logic and machine learning

Our recommendation engine performs predictive analysis on the potential errors and cross references it with both internal and external data sources to suggest updates, inclusions, or corrections to address the identified inaccuracies. Our one-of-a-kind web scraping engine scours the web to collate a single source of truth to verify provider directory data. These four components: potential error identification, confidence score recommendation/action and source of truth together provide a unique, best-in-class solution needed to solve the provider data problem.

75+ out-of-the-box rules and built-in workflow

MCheck™ Provider has a set of comprehensive rules designed to identify inaccuracies in your data as well as incomplete entries. MCheck can ingest data from other areas such as claims and contracts to identify mismatches with provider data and the dollar impact of these identified inaccuracies.

Adaptive quality rules based on machine learning

The platform has these rules that are either rooted in our cutting-edge Machine Learning models or based on our vast experience of working with leading health plans and input from our in-house SMEs.

End-to-end and seamless integration

We also offer to integrate our product with downstream systems to perform automatic updates and reduce the amount of manual intervention and time required to take action and achieve results.

Standalone Solutions
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Value for Customers
75+ out-of-the-box rules
to assess data quality and accuracy
Cost impact insights
Direct and in-direct business impact insights
Configurations to exhaustively
cover business logic/requirements
Rosters processed within minutes
of receiving updates
Customizable solutions to meet
compliance requirements
Why Mcheck™ Provider

MCheck™ Provider is an end-to-end solution, solving provider data problems. Our team consists of industry experts in the provider space, data scientists, and architects who ensure our platforms are scalable and adaptive to serve the needs of a variety of customers.

MCheck™ Provider, a one stop solution to all your provider data needs

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