Solutions For Healthcare

Enabling Interoperability in Provider Data Management

Gaine’s Provider Data Management suite drastically improves data quality and reduces overhead for Payers and Providers alike.

Payers

Payers have multiple systems that rely upon accurate provider information. These systems tend to exist independently of each other, and as a result, may contain conflicting, ambiguous, or outdated provider data. Avoidable manual processes, rework, and processing errors resulting from this poor-quality provider data impose a significant administrative cost and operational risk to any health plan. 

Provider Organizations

Provider Organizations often do not have the systems to store, validate, and maintain the provider information that is required by their contracted health plans. Provider groups incur high administrative overhead for things like roster reconciliation with plans, credentialing, provider directory attestation, and network management.

Some of the nation’s largest health plans and thousands of providers have found a better way – with Gaine’s Provider Data Management suite.

Key Features of the Gaine Provider Data Management Suite

Provider Directory

​Provider directory accuracy has been under scrutiny from state and federal regulators for some time, yet the goal of accurate, up-to-date directories remains challenging for most payers.

Our Provider Directory solution is a collaborative platform that enables provider organizations and health plans to exchange provider information in an efficient process that reduces administrative overhead for both parties.

It eliminates unnecessary outreach by phone and fax to medical offices and gives providers a trusted platform to collect and distribute information to health plans.

The Gaine platform is the backbone of the California state-wide provider directory utility – the most sophisticated and large scale initiative of its kind anywhere in the world.

Learn More about Symphony Provider Directory >

Attestation

Providers are required by state and federal regulations to attest to the accuracy of their provider directory data regularly. Our solution makes this attestation process quick and painless for providers by comparing their current profile in the Gaine Provider Directory to the health plan data and offering online attestation through a personalized portal.

Providers using the Gaine Attestation process have seen a dramatic reduction in the time and resources required by this process.

Roster Transformation for Payers

Inbound roster files from provider organizations and medical groups are transformed into a health-plan-specific format to simplify the integration of this data into internal systems.

Gaine’s Roster Transformation solution will translate all roster data into health plan standards, apply specific business validations, and report on conflicts in an online management dashboard.

Enterprise Sync

Each health plan and provider group has unique requirements when it comes to provider data management. Gaine offers Coperor Private Instance to enable an organization to keep provider data aligned across internal systems.

Each organization can leverage Coperor Private Instance to selectively distribute provider data updates to any system based on business rules and system-specific transformations.

Reference Data Gateway

Our Reference Data Gateway enables organizations to ingest provider data from external data providers and distribute this data to internal systems with precision and control.

Maximize value from externally curated provider data by ensuring that data is applied according to your organization’s data policies without the risk of overwriting your own valuable data.

Our solution uses business rules to determine which updates will be distributed to each system. Updates can be routed to data stewards for validation before being transmitted to operational applications for additional safeguards.

Data Quality Services

Implement a robust data quality program through our Data Governance workflows.

We empower each organization to develop data policies for all provider related data. These policies are applied to all systems connected to Coperor Private Instance, resulting in workflows, automated fixes, or notifications to impacted parties.

Data quality metrics are reported to a data quality dashboard, and a machine learning process refines data integration rules based on choices made through the workflows.

Case Study

Building California’s Centralized Platform for Provider Data Management

Gaine provides the platform on which the California state-wide provider directory utility is built. Learn more about the nation’s leading regional initiative for provider data management.

Provider Benefits

Help ensure regulatory compliance

As regulations pertaining to provider directory standards evolve, Gaine’s Provider Directory solution ensures that your provider database is managing all the necessary data elements and relationships properly. We take responsibility to follow legislation across state and federal authorities so your teams, as well as your Providers, can focus on the business of healthcare.

Reduced administrative headaches

Providers are required to attest to the accuracy of their provider data with contracted health plans on a regular basis. This attestation is performed via​ roster files or through a formal process defined by state and federal regulators.

Our Attestation solution eliminates roster processing and simplifies regulatory attestations by comparing your data to the health plan data and automatically generating the reports required by each plan.

Improved provider experience and relationships

Ultimately, the goal of each of these tools is to reduce the time it takes to gather, validate, and communicate provider information so that administrators have more time and resources to develop stronger relationships with Providers.

Its time to get off the hamster wheel, automate provider data maintenance, and enable your provider relations group to invest its time in developing provider relationships.

Payer Benefits

Single point of control

Gaine combines all your provider data from multiple systems and files into a single integrated database so that you can manage the quality and consistency of your provider information from a central location.

Payers can control the distribution of provider data to connected applications using an extensive set of business transactions that manage the lifecycle of provider data. The unique Coperor Opt-in Synchronization ™ process allows each application to preserve its autonomy without sacrificing control or visibility across the enterprise.

Collaborate with partners

Manage the flow of information between your health plan and your contracted provider groups. Our collaboration tools verify provider profiles and identify conflicts and changes. This collaboration provides support for formal attestation processes and roster reconciliation for Medicare, Medicaid, and Commercial products.

Reduced administrative costs

Provider data quality, or lack thereof, creates massive administrative overhead for payers due to manual processes, rework and the fallout from processing errors.

Our Provider Data Management tools will reduce this unnecessary overhead arising from bad provider data.

Ensure data privacy protection

Don’t put your provider data in the hands of unscrupulous data brokers who spam providers with unauthorized data collection outreach and then, to add insult to injury, sell this data to marketing agencies to further interrupt your providers’ valuable time.

With the Gaine platform, payers are no longer reliant upon data collection agencies for provider data validation.

Why Payers Choose Gaine for Managing Provider Data

Fastest Time to Value

Drastically reduce administrative hours collecting and consolidating data from Providers and contracted groups through our proven exchange process. Within a few week’s time, Gaine is up and running to start saving you time.

Reduce Administrative Costs

The cost associated with poor-quality provider data can be crippling. Gaine has the expertise and experience managing provider data for payers and provider groups to eliminate waste and improve the provider experience.

Eliminate Risk Throughout

Our experience and expertise in the healthcare space give us the insight necessary to identify project risks, and the skills to remove these from your roadmap. Tell us about your project! We are sure we can help. Contact us 

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