Provider Lifecycle Management

Healthcare payers constantly struggle with a time-consuming and arduous cycle that involves recruiting providers, manually checking certifications, negotiating contracts and making providers available to members. Payers must also re-verify their providers’ credentials every 2-3 years, making this cycle an ongoing challenge.  With Appian, Luxoft offers an application for managing this process, which includes automated primary source verification (PSV) tools for credential verification. The Provider Lifecycle Management app allows plans to onboard and manage their provider enrollment cycles much more quickly and with process rigor. Instead of manually performing every step, this solution provides a digital overlay that integrates with existing systems and creates a unified interface.  This allows payers to consistently manage the provider lifecycle process and automate PSV to reduce errors and avoid credential verification delays.

Key Features and Functionality:

  • Ability to create, assign and manage provider network "Recruitment Needs" tasks to Provider Network Managers
  • Ability to track subsequent 'Recruitment Lead' status and effectiveness of recruiting efforts
  • Automated NPI Validation utilizing npiregistry.cms.hhs.gov
  • Ability to track required documents and associated status of the documents
Anonymous