The Value of Maintaining Provider Data Accuracy
Coventry understands the value of maintaining accurate provider data; therefore, Coventry is taking aggressive action to ensure network data is current and accurate. Coventry has a robust, multi-faceted network management program that ensures all network providers are verified on a regular basis. In addition to reviews of a provider’s credentials during contracting, providers are recredentialed every three years. Additionally, Providers’ location specific information is verified at least once a year (more frequently in some MCO states). This verification confirms the provider’s ability to accept new patients and confirms the location’s demographic information. Coventry’s ongoing Provider Demographic Monitoring verifies providers are still actively treating every quarter.
Data accuracy is important so that patients and their representatives, who need to find care, are able to be seen by someone who can quickly provide care.
How does Coventry maintain data accuracy?
Coventry's Network Operations department maintains the accuracy and consistency of information across all provider applications, including Internet applications, channeling tools, Panel creation, 24/7 telephonic directory and print directories. We utilize a global provider database, which serves as the primary repository for provider information. This database is the source system for all our applications requiring provider information.
System validation requirements are in place for the data elements we load into the provider database. Furthermore, audit processes verify that we are following all processing guidelines, and we measure our percentage of compliance with that process on an ongoing basis. Coventry's provider data specialists are responsible for inputting PPO network updates. Our Network Operations department is responsible for maintaining all aspects of the network data.
We update our provider database daily, so provider and rate information is up-to-date and accurate for our clients. All contracts are entered into the system prior to the provider's effective date, so there is no lag time.
Coventry validates Provider data from many sources:
- WC Client Services
- Provider Supplied
- Bill Experience
- Roster Management
- Demographic Monitoring
- Client Supplied Data
- Personalized Outreach
- Provider Portal
Coventry appreciates collaboration with our clients on Provider Demographic Currency. Please continue to make us aware of any discrepancies or inaccuracies in our data, as we strive to make the Coventry Provider Network as accurate as possible.