Data Cleansing and Verification (DCAV) services
Health plans have more data than ever before. But more important than the quantity is the quality of their data. DCAV is often necessary to bring consistency to health plan’s data, especially when it has been lifted from numerous, disparate data systems and sources.
Sutherland’s DCAV solutions provide accurate, up-to-date provider information and utilize a combination of RPA, web search validations, and direct provider outreaches to achieve the highest accurate data provider in the most cost-effective and timely manner.
Provider Appointment Availability Survey (PAAS)
Many states require health plans to report on a range of mandated requirements, from network adequacy to timely availability of appointments. Sutherland provides state of the art survey services to meet these needs by deploying our SmartPDM workflow solution. We facilitate and track end-to-end survey outreach and reporting activity, including network roster uploads, data file creation and de-duplication, outreach detail, and compliant reporting. Our shared services model approach to survey administration provides efficiencies by consolidating outreach in areas where networks overlap, effectively reducing provider survey fatigue.
Credentialing Process
Members know very little about their doctor other than what they see hanging from an office wall. Medical credentialing is increasingly important because it’s the one process that allows members to gain trust in their health providers. Through a data collection process, primary source verification, and committee review by health plans, members are assured of their health provider’s qualifications and experience.
Sutherland supports health plans in the collection of primary source verification documentation, outreach services for missing information, automates data entry, and provides complete credentialing packets that are ready for health plans to review.
Provider Database Updates and Maintenance
Provider directories are only as accurate as the underlying provider databases maintained by the health plan. Sutherland professionals transform provider database updates and changes from multiple channels into reliable data across multiple systems. Our teams touch over 300,000 provider records every month and utilize state of the art tools to maximize quality and productivity.
Sutherland brings a digital touch to setting up new providers, processing changes, terminations, demographic updates, and completing all of these data management tasks in a timely manner. Through our automation platforms, we’re able to assist in the administrative burden by increasing the speed of updates of inaccurate provider data and improve the overall quality of all health provider information.
Provider Recruitment Management
Health plans are racing to capture as many new, profitable members as possible. However, a key long-term success factor will be quickly recruiting and onboarding high-quality physicians. Finding, attracting, and partnering with high-quality physicians is a key component to improving the member experience and the overall success of the health plan.
Sutherland provides exceptional recruitment programs by leveraging our portfolio of contact center platforms and highly-qualified professionals to work with all types of health providers. We create a strong connection with recruited physicians, explaining the health plan’s contract terms and working closely with them to answer any questions they have and overcoming any objections.
