Provider Data Accuracy

Update your provider data in one place

We coordinate updates of your Provider data to all of your affiliated Health Plans, making provider data validation easy and convenient.

Health Plan Coordination

PRIME works closely with health systems and provider groups, providing 100% coordination of provider data updates to all affiliated health plans.

PRIME coordinates provider data updates on your behalf to the health plans reaching out to you and systemically determines variances between your data and the health plans based on their criteria, ensuring that the health plan receives accurate, complete, and timely data from your organization.

Concierge Coordination and Support

If you don’t have time to update your profile online, give us a call at +1 856 886 8088. Our agents will update your data at your convenience.

Ease of Use

PRIME offers an online portal for providers to update data conveniently. PRIME’s call center is also available for providers to speak with an agent to assist with data updating. Providers who utilize PRIME embrace efficient and automated data updates, allowing them more time to focus on the patient.

Roster Integration

Our technology provides file integration and can also connect directly to your EHR to retrieve your Provider data updates.

Keep All Health Plans Updated

We reconcile differences between your current provider data and a Health Plans version of your data in their systems. We work directly with all of your affiliated Health Plans so you don’t need to address with each individually.

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Roster Integration

PRIME integrates with top Provider Data Management (PDMS) & EHR Systems, as well as Proprietary Health Plan systems

Support for the No Surprises Act

The No Surprises Act requires insurance agencies to maintain accurate provider directories. The legislation mandates that Health Plans must:

  • Maintain Provider data within directories at least every 90 days
  • Update Provider data in downstream systems within 2 days
  • Remove unverified Providers from directories.

PRIME’s capabilities are aligned with each of these requirements, which are in addition to the existing CMS regulations applicable to Medicare, Medicaid, and QHP. PRIME integrates with popular EHR systems like EPIC and supports secure file integrations that facilitate the bi-directional workflows of Health Systems and Provider groups.

Provider Training

Online Training

PRIME uses state-of-the-art technology to provide a positive, structured, and fully customizable training experience. We ensure that network providers are fully trained for delivering quality care, including CMS Special Needs Plan Model of Care (SNP MOC) and more!

Build competencies

Log attendance lists and incorporate competencies related to specific job functions. Competency modules include Integrity and Compliance, Fraud and Abuse, Cultural Competency, HIPPA and Confidentiality.

We Follow Up

We use our direct outreach methods to follow up with each of your providers. We will track their status and send each provider a certificate upon completion.

Special Needs Plan MOC

Provider Training

Special Needs Plan MOC
Online Training

PRIME uses state-of-the-art technology to provide a positive, structured, and fully customizable training experience.
We ensure that network providers are fully trained for delivering quality care, including CMS Special Needs Plan Model of Care (SNP MOC) and more!

Build competencies

Log attendance lists and incorporate competencies related to specific job functions. Competency modules include Integrity and Compliance, Fraud and Abuse, Cultural Competency, HIPPA and Confidentiality.

We Follow Up

We use our direct outreach methods to follow up with each of your providers. We will track their status and send each provider a certificate upon completion.