Issue link: https://insights.evolent.com/i/1473175
© 2022 Evolent Health LLC • EHS-2212494-0706 Provider Matching Having established the list of known contracts, Evolent began linking them to individual providers at the level of detail needed to process accurate claims. To accomplish this, we deployed a phased approach to reconcile providers with contracts, matching first by TIN, followed by NPI1, service location, and Business Unit/NPI2. Subsequent phases validated the provider specialty with a clear indicator of whether they were a primary care provider or specialist. We also cleaned and validated the provider rosters, by removing duplicates and old records and correcting data errors. Data Validation With the plan's provider data updated and reconciled, we turned to Evolent's Provider Pipeline solution to validate it against quality and data standards. Pipeline simultaneously audits provider data files against third-party sources, such as the National Plan and Provider Enumeration System and postal service address data, as well as against internal quality controls and client-customized validations, to ensure the data are accurate, the files are appropriately formatted, and all mandatory data have been received (TIN, NPI, etc.) Pipeline creates a success/reject file to document which records passed validations and which require review, rework and resubmission. RESULTS Through these efforts, we drove major improvements in the quality of network provider data, benefitting providers, members and the plan alike. Achievements: Seeking a Match for Your Plan's Provider Data Management Efforts? Email EHSPartners@evolenthealth.com to learn how we can help you tackle this and other challenges in health plan administration. 98% match rate across TIN, NPI and location (up from 32.7%) >15% increased accuracy of overall provider directory ~10K members with more accurate PCP assignment