Large health plan
- 1. 2 MILLION+ HEALTH PLAN Case study for Atlas Prime
- 2. OVERVIEW • The client is a large health plan on the east coast • 2 million Medicare, Medicaid and Commercial members • 150k provider locations • Had outdated/stale provider demographic data • Published provider directory information was over 30% inaccurate • Considerable member and provider abrasion created regulatory actions.
- 3. CHALLENGES • Provider demographic data validation not a core competency • Urgency to correct and produce accurate print and on-line provider directories • Directories with greater than 95% accuracy rate • Internal IT resource constraints • Requirement for audio recordings/scanned images of all provider outreach encounters for third party audit/Quality Assurance • Need to update provider data on a regular basis
- 4. SOLUTION • Health plan contracted with Atlas Prime to validate provider demographic data for each provider location in its networks. • Atlas Prime validated provider locations via call center, fax, email and self-service options. • Atlas provided a solution that all telephone encounters were recorded and printed materials were scanned and archived for audit and quality assurance purposes. • Calls were conducted by highly trained, US based call center representatives. • Atlas internal quality assurance program drove high rate of data accuracy.
- 5. RESULTS • Health plan saw immediate improvements in provider demographic data accuracy in printed and on-line directories. • Translated to increase in member and provider satisfaction levels. • Reduction in contacts with health plan customer service representatives. • Additional positive impacts were achieved in regulatory surveys and compliance overall.