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In effort to authenticate doctors’ information, AI-powered product strives to not only improve compliance, but also increase satisfaction among members and providers.
Conduent Incorporated, a business solutions and services company, introduces a new Provider Data Management (PDM) solution that brings health insurance companies a single, real-time data source to ensure the accuracy of their doctors’ directories. The PDM uses artificial intelligence (AI) and advanced analytics to collect, validate, and communicate a doctor’s participation within a network, demographic revisions, and other data points.
The company’s newest solution enables health insurance companies to improve claims auto-adjudication rates by reducing common data errors—such as incorrect addresses and specialty information—and can reportedly improve doctor and member satisfaction with accurate, up-to-date information to avoid surprise bills and connect the patient to the proper in-network provider. If there is missing or incomplete information, call center professionals reach out to providers for verification.
The No Surprises Act mandates that health plans update their directories within 48 hours of changes to doctor information to avoid penalties. As health insurance companies continue to use manual processes, they run the risk of noncompliance with the law.