PDM Fundamentals
This term refers to the centralized system used to manage and maintain accurate information about healthcare providers within an organization.
What is Provider Data Management?
Inaccurate provider data can lead to this issue, where patients are billed unexpectedly for out-of-network services.
What is surprise billing?
Accurate provider data enhances this aspect of patient care by ensuring patients can find appropriate in-network providers.
What is patient access to care?
Certify's value proposition in PDM is in unifying this layer of the technical stack.
What is infrastructure?
This type of data includes provider specialties, addresses, and network affiliations.
What is provider demographic data?
This term describes directories listing providers who are not actually available, leading to access issues for patients.
What are ghost networks?
Effective PDM contributes to this operational benefit by reducing claim denials and administrative costs.
What is operational efficiency?
This technology can be layered on top of a health plan's PDM to drive outsized value in network design and modeling.
What is Artificial Intelligence?
Maintaining accurate provider data is essential for this process, which involves making sure providers are accurately reimbursed
What is Claims Payment?
A common challenge in PDM, this occurs when the same provider is listed multiple times with slight variations.
What are duplicate records?
By reducing errors and improving data accuracy, effective PDM can lead to this financial outcome for healthcare organizations.
What is improved financial performance?
Provider portal is one way providers can update information in Certify. This is the other 'bulk-upload' type.
What is roster uploads or RosterOS?
This federal act requires health plans to maintain accurate provider directories to prevent surprise billing.
What is the No Surprises Act?
According to industry estimates, healthcare organizations lose billions annually due to inefficiencies in provider data. This specific percentage of total administrative costs is attributed to siloed or inaccurate provider data.
What is 20%?
This advanced data management approach used in PDM systems consolidates provider records from multiple sources into a single, authoritative version, ensuring consistency across systems and enabling downstream applications like claims, credentialing, and network design.
What is Master Data Management (MDM)
Certify’s PDM platform creates this type of strategic value that increases with each new client or provider.
What is a network effect?
This concept refers to the ability to maintain a complete and current view of a provider by combining internal records, partner data, provider self-attestation, and regulatory sources into a single, unified record.
What is a golden provider record or unified provider profile?
This term refers to the administrative burden and frustration experienced by providers due to repetitive data submissions.
What is provider abrasion?
This data governance strategy is essential to PDM and ensures that each data field (e.g., specialty, group affiliation, practice address) is consistently defined, validated, and traceable to its source system across an organization.
What is data lineage and/or survivorship rules
This aspect of Certify's infratructure setup enables multiple clients to have their own domains, while feeding into the unified domain.
What is multi-tenancy?