Solutions For Health Plans
Provider Data Accuracy and
Primary Sourced Validation
- Our organization, processes, and platform are aligned with your goals
- Direct outreach to contracted Health Systems, Provider Groups, and Individual Practitioners
- Data validation at the source
- Convenient validation channels that align with the capabilities of your Providers
Options that align with your provider network and product goals including:
- Federal (CMS) compliance
- State regulatory compliance like CA SB137
- The No Surprises Act compliance
Superior Data Quality, Completeness, And Results
- 100% direct outreach via convenient channels
- 95% client-audited quality assurance
- Up to 90% validation success rate
- Less than one (1) month of implementation to go-live
- Outcome-based pricing
- Full audit transparency
- Dashboard analytics and reporting
- Integration to your Provider Data Management (PDMS) and EHR Systems
- Machine-learning, AI, and data enrichment
Instant, High-Quality, Print-Ready, ADA-Compliant Provider Directories
Enhance customer experience by managing information in a directory format to help members easily identify in-network providers.
CMS mandates that print directories be made available for patients over 65 years old. We enable flexible, print-ready PDF directories that comply with all applicable regulations.
Our Accessibility Directories are ADA-compliant and are designed, developed, and edited to provide members with equal access to information in a functional format.
Automated integrations with the PRIME platform will facilitate timely updates of the Provider data stored in your Provider Data Management System.
Mock Audits Preparation
Mock Provider Data Audits
PRIME can assist with the identification of data errors and anomalies to help prevent potential compliance violations in advance of an actual audit. We have extensive experience with audit preparation, including mock CMS and state provider directory audits.
We work closely with Health Plans to understand the nuances and business needs of the audit process according to federal and state regulations. PRIME provides results that help you resolve issues and prevent potential compliance violations.
PRIME uses state-of-the-art technology to provide a positive, structured, and fully customizable training experience.
We ensure that providers in your network are fully trained for delivering quality care, including CMS Special Needs Plan Model of Care (SNP MOC) and more!
Log attendance lists and incorporated competencies related to specific job functions are included. Competency modules include Integrity and Compliance, Fraud and Abuse, Cultural Competency, HIPAA, and Confidentiality.
Our direct outreach methods provide personal follow-ups for your Providers. We track their progress and send each Provider a certificate upon completion.
Back Office Support Services
PRIME Back Office Support Services enable Health Plans to:
- Augment existing resources
- Scale staff support in anticipation of inbound and outbound call demand and support
- Support peak call periods such as annual renewals and re-contracting
- Positively impact call center key performance indicators (KPIs), i.e. average speed of answer (ASA) and abandonment rate
PRIME’s call center manages calls and ensures constituents’ issue resolution. Our call agents specialize in Health Plan member and provider communications.
- Inbound and outbound call agents providing 24/7 support
- Dedicated toll-free number
- Custom IVR, call treatments, and agent scripts
- Call-back scheduling
- Voicemail and chat management
- Real-time or daily file and activity updates, including escalations
- Dashboard reporting with standard KPIs and SLAs