Healthcare Product Suite
Know Your Provider – (KYP)
Industry’s First Smart and Modular Provider Network Management System
Know Your Provider, a first-of-its-kind solution from Digital Harbor, is a clever and collaborative Provider Credentialing application that offers end-to-end Provider Network Management (PNM) while seamlessly complying with Medicaid regulations. Provider Network Management (PNM) operationalizes all data, analytics, workflow and reporting associated with Provider data and is responsible for screening validation, revalidation and ongoing monitoring to ensure a high-quality and complaint provider network.
PNM manages all provider enrollments, accounts, affiliations, relationships, communications and contracts end-to-end. PNM modules also include Site Visit Management, Provider Directory, Provider Network Adequacy, Fees and Service Management, Performance Management, Quality Improvement Management and more. KYP makes the entire process a completely “paperless” exercise and automates at least 80% of the activities which are done manually today.
Major Modules of KYP
Delivered using Social Form, KYP offers a first of its kind intuitive and intelligent portal for the Providers struggling with complex application forms. The portal talks to Providers and assists them in filling out forms without them having to understand the State specific policies and requirements. Acting as their digital assistant it dynamically changes the flow of the application based on the provider’s context asking the right information and documents applicable to each specific provider. Providers can thus smoothly complete their applications without the need for prior understanding of State specific requirements and policies. The Portal allows the providers to complete an application package in any order and across multiple sessions. Even better, multiple users can work on an application together across desktops and smart phones, chat together and even interact with enrollment analysts throughout the enrollment process.
Delivered using Social Case, KYP Enrollment transforms the life of Medicaid Enrollment analysts by enabling complete and intelligent automation of provider data verification process. KYP is the only solution enabling end-to-end automation including application review, external verification, risk-based decision analytics and account management; thus reducing the unnecessary returns and shrinking the enrollment processing cycles from months to days.
Delivered using Social Analytics, KYP Screening makes provider screening a completely “paperless” exercise and automates at least 80% of the activities which are done manually today. KYP uses complex entity resolution techniques to verify enrollment information against more than 15,000 best of breed data sources. KYP computes an aggregated provider risk score and an unprecedented 360 degree view of provider including history, qualifications, affiliations, adverse actions and negative news across time and geography And all of this information is made available to Medicaid analysts using an intuitive dashboard to form quick and constructive opinion about the providers.
Delivered using Watch List Management, KYP’s Monitoring module completely automates the monthly monitoring requirements for providers. Not only does it automate the mandatory checks against exclusion lists and licensed boards, it provides optional checks against federal, state and local criminal records. KYP provides comprehensive research and investigation tools within a digital workflow to triage and generate the alerts and to adaptively learn from false positives to increase the accuracy of future alerts.
- Gives complete control on managing provider applications.
- Increases efficiency of users through digitization and automation
- Reduces process cycle times and enhances adherence to SLAs
- Improves customer service through superior interaction and collaboration
Some Of Its Features
With the worlds’ first talking portal, the application talks to providers and assists them in the process. The application proactively learns from the provider input and adapts to their requirements. It binds information, documents and stakeholders together.
Guides analysts in understanding end-to-end provider background. The application provides a comprehensive 360 degree view of providers and their affiliations.
Gives comprehensive workflow history
It gives the enrollment analysts with detailed and intuitive view of the case workflow and milestones such as the comments and findings added by other analysts, queries raised by supervisors and attachments related to the case across the workflow.
Screens providers against 15,000+ data sources
KYP adds intelligence to provider disclosed information. Apart from the Medicaid mandated checks, KYP seamlessly screens the providers and its affiliates against several different sources to give an expert insight to the enrollment analyst
Provides a risk score based assessment
Based on the screening results, KYP adds intelligent risk scores to provider applications based on several identified traits. KYP also enables the enrollment analysts to modify these scores and add their findings. KYP also provides risk radial plot for the analysts to understand the distribution of risks for the given case.
Assists analysts in making informed desicions
KYP adds intelligence, provides an intuitive social dashboard, offers 360 degree view, suggests next best possible steps on the case and assists analysts in making informed provider enrollment decisions
Maintains provider accounts
KYP creates and maintains the account for all the approved cases. KYP enables the analysts to investigate the accounts and offers proactive analytics to make modifications to their status at any given timeframe
Classifies form into logical sections, eliminates repetition, and provides progress indicators at various levels
Built-in questionnaires to guide providers to the right forms supported by proactive help
Supports data auto-fill, validates data contextually and provides profiles and resource library for data reuse.
Supports secure message exchange with Enrollment departments, and application sharing with related user accounts
Allows providers to view and manage account data including updates, re-enrollments, affiliations
Completely secures provider data and documents, supports multi-factor authentication, and uses e-signatures to control form submission