Ideon and Prudential explore a new, proactive approach to uncovering EOI errors—before they cause claims issues.
Author: Ideon
Eliminating EOI Data Risk: Why Carriers Need EOI Auditing Now
Table of Contents
Managing Evidence of Insurability (EOI) data has become a critical—and challenging—priority for group benefits carriers. Traditional EOI processes often result in errors that expose carriers to significant risks, from Department of Labor (DOL) fines to reputational harm and poor member experiences.
This guide dives into the risks hiding within routine EOI data processing. We’ll examine why carriers struggle to identify missing EOI before it’s too late, and reveal how advanced EOI data auditing prevents errors, mitigates risk, and helps carriers stay ahead in a competitive market.
The Status Quo: Challenges in Identifying Incomplete EOI
Most carriers can’t effectively detect and resolve instances where a member has enrolled in coverage that requires EOI but hasn’t completed the EOI process. This problem is more common than many realize and has far-reaching implications.
The Problem: EOI errors are difficult to detect
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- Enrollment With Incomplete EOI: Members often select life or disability coverage that exceeds guaranteed issue amounts, triggering the need for EOI. However, due to gaps in enrollment data exchange, complex plan eligibility rules, the BenAdmin misconfiguring plans in its system, or miscommunication, the member may not complete the required EOI process.
- Invisible Discrepancies: These incomplete EOI cases frequently go unnoticed because carriers rely on manual checks or systems that can’t flag these discrepancies.
- Delayed Detection at Claims Time: The failure to identify these issues means that carriers often discover them only when a claim is filed. At this point, it’s too late to rectify the oversight without causing delays and member dissatisfaction.
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The Impact: What happens when EOI errors go unnoticed
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- Financial Risk: Carriers can face lawsuits and fines from the Department of Labor (DOL) if claims are denied due to missing EOI, especially if the member was paying a premium for supplemental coverage. In just the last two years, several large carriers have reached settlements with the DOL over their EOI practices.
- Poor Claims Experience: Mistakes in EOI collection lead to negative member experiences, especially at claims time—when a slow process or wrongly denied claim can be disastrous for the member and their family. And, these negative experiences could result in brokers and employers taking their business elsewhere.
- Reputational Damage: Brokers increasingly prioritize carriers with automated, advanced EOI capabilities. Those who don’t meet this expectation may find themselves losing out on key business opportunities and RFPs
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Simply put, the status quo is no longer sustainable for carriers looking to remain competitive and compliant in the modern benefits landscape.
Making EOI Data Management a Strategic Priority
The consequences of mishandling EOI are extensive. But there’s light at the end of the tunnel — carriers, with the right auditing technology, can solve EOI data challenges and mitigate risk. Here’s why it should be a top priority:
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- Rising Demand for Automation: Brokers and employers expect streamlined, automated EOI processes to enhance the member experience, speed up enrollment, and reduce errors. Some RFPs even request information about EOI automation, including API capabilities.
- Revenue Growth Opportunities: Carriers that simplify EOI processes see higher adoption rates for supplemental benefits like life and disability coverage—opening new revenue streams.
- Mounting Regulatory Pressure: With increased scrutiny from the DOL, carriers face a higher risk of costly fines and reputational damage if EOI data errors aren’t addressed proactively.
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EOI Audit by Ideon: An Industry-First Solution to De-Risk EOI Data
Better technology is the only way to minimize the financial and reputational risk of EOI errors.
Ideon’s EOI Audit solution offers a unique, automated approach to solving this industry-wide challenge. It addresses two key areas: data auditing and decision return. Here’s how it works:
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- Identifies Members Requiring EOI: Ideon’s system pinpoints members whose elections require EOI.
- Audits Groups for Missing EOI: The audit function flags members who require EOI but didn’t complete it. Errors and discrepancies include why someone needs EOI, based on the carrier’s plan eligibility rules, decisions already in the carrier’s system, and group enrollment data.
- Error Resolution: All discrepancies are surfaced through automated reports and dashboards. Each issue has a clear, actionable resolution path, allowing carriers to avoid downstream problems.
- Decision synching: EOI statuses and decisions are synched between carriers and BenAdmin platforms, ensuring up-to-date, accurate data across all systems.
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This process not only improves data accuracy but also prevents costly errors that lead to DOL fines and poor member outcomes.
Results with EOI Audit
By implementing Ideon’s EOI Audit solution, carriers not only improve compliance and enhance claims experiences, but also strengthen their competitive position by offering a more reliable EOI process. Here are the key benefits they can expect:
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- Risk Mitigation: Proactively address EOI discrepancies to avoid DOL fines, reputational harm, and operational disruptions.
- Faster Resolution: Early detection and actionable insights mean carriers resolve EOI discrepancies quickly, avoid downstream problems, and process claims accurately.
- Stronger Market Position: Showcase advanced EOI capabilities to stand out in RFPs, win more business, and build stronger broker relationships.
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Success in Action: How Prudential is Using Ideon’s EOI Audit Solution
Carriers like Prudential are already seeing positive results with Ideon’s EOI Audit solution. As Sherri Bycroft, Director of Benefit Technology Partnerships at Prudential, shared in a recent Ideon Insights interview:
“We’re really excited about the fact that it’s going to flush out issues much earlier on,” she said. “We can have full confidence that we have the right information about the members in our system, and at the time of claim, be able to pay that without delays.”
Get a Demo of EOI Audit by Ideon
See how Ideon’s EOI Audit solution can help you reduce risk, identify missing EOI, and provide a better claims experience. Schedule a demo below.
Employee Spotlight: Christie Lickert
At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… Christie Lickert, our Senior Operations Analyst!
Name: Christie Lickert
Department: Enrollment Operations
Title: Senior Operations Analyst
Location: Omaha, NE
Work
How long have you worked at Ideon?
I have worked at Ideon in Enrollment Operations for two years.
Tell us about your day-to-day.
I work with carriers and platforms, specifically with configurations for EDI and API feeds. Each day, the work I do is different. I can be working on anything from a brand-new implementation with testing to creating documentation on processes and training new team members.
What projects are you excited to work on?
I love working on projects that are challenging and give me a sense of accomplishment. I enjoy it when I can contribute to solving issues with an out-of-box approach.
What excites you about the future of Ideon?
Ideon has many partnerships that are so influential to the growth of our company. We are constantly trying to make the customer experience as seamless and efficient as possible. I am excited to see what innovative ideas my colleagues and I produce to help support that.
Describe your onboarding experience.
What’s great about Ideon is that we have every new employee meet with each department to get a look at what we do. It was interesting and informative to see what each team member’s purpose is. The team is also very welcoming and inclusive. Ideon is very thorough with onboarding and makes sure everyone has what they need to be successful.
Life
Favorite activity when you’re not working?
I love reading and am part of a book club. My favorite genre of books is a tie between autobiographies and thrillers.
Favorite place you’ve traveled?
My favorite place I have traveled to is Sedona, Arizona. I absolutely love the red rock and enjoyed going on a “Pink Jeep Tour” which drove me up and down cliffs.
Interesting fact about yourself… Go!
I am obsessed with the Golden Girls. I still have all their box set DVDs, and my first dog was named after Sophia Petrillo.
Webinar: The Future of Group Benefits Quoting
How are quoting platforms transforming the ancillary and voluntary benefits space?
Carriers and brokers are rapidly evolving their engagement—and third-party quoting platforms are at the heart of this shift. Join this webinar as experts from Guardian, Acrisure, and Ideon explore how these platforms are shaping the future of group benefits quoting.
🗓 Date: Tuesday, Oct. 22
🕒 Time: 1:00 PM ET
👉 Register here.
What you’ll learn:
- The rise of quoting platforms and their role in benefits distribution
- How carriers are partnering with platforms to reach more brokers
- Key opportunities in the small group market
- Success stories and trends
- How APIs and automation are streamlining group benefits quoting
De-risk Your EOI Data: Introducing IdeonEOI
IdeonEOI detects missing and incomplete EOI, protecting carriers from unrecognized risk.
Ideon Insights: Prudential’s Sherri Bycroft on carrier-BenTech connectivity and APIs
Welcome to Episode 5 of Ideon Insights, our monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In this episode, we sat down with Sherri Bycroft, Director–Benefit Technology Relationships at Prudential, to discuss how carriers are prioritizing certain APIs, partnerships with technology platforms, and how Ideon and Prudential developed an advanced solution for EOI auditing and decisions.
In this insightful Q&A, Sherri shares how Prudential is approaching the future of partnerships and technology, and why connected experiences are the key to growth and member satisfaction in the benefits space.
Watch the full episode of Ideon Insights. Below, we’ve highlighted key moments from the conversation.
IDEON: Why are technology partnerships so important for carriers like Prudential today?
SHERRI BYCROFT, Prudential: 15, 20 years ago, we often didn’t know who the platform was that housed data for that customer until after they were sold. Now, it’s on the RFP. If we don’t have a relationship with a group’s technology partner, we could be dead in the water on the sale before we even get to quote it. They’re going to look at that and say, ‘we’re going to choose a carrier that wants to work with our partner.’
It’s just so important in today’s world to be able to exchange data and have a connected experience. My team is being invited to finalist meetings all the time now. They want to hear from the technology team: What are you offering? How are you connecting? What does that look like for me? Connected technology experiences are where they’re making decisions today.
How has the role of brokers evolved in this more connected benefits landscape?
10 plus years ago, you didn’t really see brokers being engaged in how or who a group was choosing for their technology partner. Now brokers are actually bringing technology solutions directly to their customers. It’s creating some stickiness for the broker.
We’ve seen it on the carrier side, that customers are now more committed to their technology solution than they are to a carrier or their broker. The loyalty now is to ‘what is the hardest part of my life to change, and that’s the technology.’
What technologies and APIs are carriers prioritizing now?
Decision support is definitely a huge point of interest right now. Another is quoting APIs. The quote process wasn’t even in conversation five years ago, but now it’s a huge point of interest.
Plan data is another area where we’ve seen progress. We’re finally at a point where carriers are rolling out solutions to send plan configuration data into the technology system.
Everybody’s working toward their own roadmaps and some are very strong in one place and maybe not so much in another. We used to just be so focused on enrollment and eligibility information. But now, our eyes have been opened a bit as to what we can do to make the experience better, and be more proactive in preventing issues with that enrollment data. And so that really leads to plan build and Evidence of Insurability (EOI), and even quoting, all being an interconnected technology experience from quote to claim.
Why did Prudential choose to partner with Ideon?
One of the main reasons Prudential decided to partner with Ideon is because the folks at Ideon understand there’s more opportunity than just what’s being accomplished today. That willingness to say, ‘hey, there are opportunities to do things that have never been done before–let’s find a way to do it together.’
It gave us a lot of excitement for what we could do together, instead of being so siloed in, ‘the technology partner versus the carrier and whose roadmap is more important’. Instead, we have a partner like Ideon, where we are really both committed to delivering something new and better to the market.
How are Ideon and Prudential working together to solve EOI data challenges?
The EOI audit process that Ideon is creating for us is really taking the EOI rules that we have around our plans, and applying them to the enrollment data that’s received from the technology partner. The solution looks at how many of these folks have an amount approved over a guaranteed issue amount, and whether they actually went through the EOI decision process.
By having this EOI audit in place, we can uncover problems before claims time, and prevent a negative claims experience. It’s really important to us to ensure that we’re doing that right. But we just didn’t have the mechanisms in our toolbox to create this. So, Ideon has helped us build this from the ground up. We’re really excited about the fact that it’s going to flush out issues much earlier on.
It also ensures that the EOI decisions that we’ve made have been correctly updated into that technology platform. This actually serves in between as that connectivity, and reports back if we’ve approved something and it’s not updated in that downstream system. It’ll flush out issues and report it back to the platform, so we can make sure that it’s corrected.
How does Ideon help improve data quality for carriers?
The only thing that solves data quality issues is having robust validations on that data. Ideon has applied a more robust set of validations to all of our transactions. If the data is not in good order, Ideon catches it at the time they receive it and doesn’t pass it on to us. This helps keep bad data out of our system and reduces operational costs.”
What’s the state of API adoption in the benefits industry?
I think we’re still in our infancy, maybe toddler stage, but we certainly have a long way to go. I remember sitting in a room full of carriers and we were having discussions around APIs in 2016, and it was like everybody wanted to be there by 2020. We’ve learned a lot since and we’ve seen how long this has taken, but I think like all technology, you’re going to see it start to accelerate. But how far along are we going to be? We might be getting ready to enter our teenage years.
Get a Demo of EOI Audit by Ideon
Learn more about how Ideon’s EOI Audit solution can helps carriers reduce risk, identify missing EOI, and provide a better claims experience. Schedule a demo below.
Stay tuned for more episodes of Ideon Insights each month! To get the latest updates and industry trends, subscribe to our newsletter below.
How carriers use quoting platforms to boost ancillary benefits sales
Summary
Market-leading ancillary and voluntary benefits carriers are leveraging digital quoting platforms to increase sales and expand their reach. These platforms simplify the quoting process for brokers, particularly in the small group market, and connect carriers to new opportunities, By integrating with these platforms, carriers are ensuring their products get more visibility and fostering stronger broker relationships.
A growing number of carriers selling ancillary products for employee benefits are overcoming initial concerns about third-party quoting platforms, embracing them and discovering a significant source of incremental sales.
In the earliest days of these platforms — which enable brokers to gather quotes from multiple carriers — some insurers were concerned that their products would be reduced to a line on a spreadsheet. They wanted brokers to continue to get quotes from their reps or their websites, allowing them to build a relationship with agents and highlight the unique benefits of their products.
Brokers, though, resisted the time-consuming process of gathering multiple quotes one at a time. Many had already used quoting platforms in personal and commercial lines and wanted the same convenience when pitching benefits plans. The platforms make preparing a client proposal much faster, and typically integrate quite well with agency management systems.
Although brokers initially used the benefits quoting platforms to manage the complexity of group health policies, many appreciated how the platforms also streamlined quoting for ancillary products. They could find the right plans and add them to a proposal in a few clicks.
The result: Carriers that chose to work with the quoting platforms discovered that they’re generating incremental sales. Rather than undercutting their existing relationships, the platforms connected carriers to brokers they had never worked with before.
Success stories: Carriers are thriving by partnering with quoting platforms
Principal Financial Group, for example, began distributing through quoting platforms as part of a strategy to convince brokers to add its ancillary products to group medical proposals. “A lot of brokers are finding their medical compensation is getting squished, so we can make it easy for them to add more lines of coverage,” said Eric Weiford, a senior relationship manager at Principal, in an Ideon webinar.
“Platforms are not the enemy,” he added. “They get more eyes on our products from people who don’t know us today but will in the future.”
The advantage is particularly powerful in the small group market, where the efficiency of quoting through platforms radically improves the economics for both brokers and carriers.
“Efficiency is king, especially with small groups,” Elek Pew, Head of Digital Partnerships at Beam Benefits, told Ideon. “We pride ourselves on meeting distributors where they are. If they use a third-party system to quote business, we’ll find a way to integrate with that platform.”
Beam’s modern, digitally-native systems and APIs allow it to generate custom quotes for any size group, even when it is connecting to brokers through a third-party platform.
“There’s a huge opportunity to deliver real-time, custom underwritten rates to small groups, especially through quoting platforms,” said Hannah Thompson, a Beam senior solutions architecture manager, in the webinar. “We can provide really sharp rates that only large groups could benefit from in the past.”
Exploring the quoting platform landscape
More quoting platforms are entering the market each year, bringing a range of tools designed to enhance the quoting process for brokers and carriers alike. Some of the existing platforms in this space include:
Additionally, some brokerages, such as Word & Brown, have developed their own proprietary platforms to further streamline the quoting process.
Getting started: Integrating with quoting platforms
Before carriers start working with benefit quoting platforms, they must decide how they will distribute their product details and rates. Those with up-to-date systems can connect in real time over an API. Carriers can also send their rates to the platforms in spreadsheets or other formats. Some have found that juggling communication with multiple platforms and keeping rates up-to-date can get cumbersome.
A more efficient alternative? Carriers can work with data solutions companies like Ideon. A carrier simply provides its rates — in whatever format is convenient — and Ideon will distribute them to dozens of platforms over its proprietary API connections, providing brokers with a seamless quoting experience. Whenever carriers upgrade their systems to support quoting over APIs, Ideon can facilitate two-way communication to enable customized, underwritten quoting and other advanced services.
Even for technologically advanced carriers like Beam, working with Ideon to get its products on quoting platforms provides the broadest possible distribution. “We’ll connect to third-party platforms directly if that’s their preferred method,” Thompson explained. “Some will say, ‘We want to connect through Ideon,’ and we’re more than happy to make that happen.
“It makes our jobs a lot easier knowing we have a trusted player in the middle.”
Expand your reach to today’s leading quoting platforms, without any technical development. Carriers can reach out to Ideon here to get started.
Myths vs. Reality: Why Benefits Carriers Partner with Quoting Platforms
Over the past few years, leading ancillary and voluntary carriers have increasingly partnered with third-party quoting platforms. These platforms, favored by benefits brokers, allow for the quoting of plans from multiple carriers and streamline the proposal process. For brokers, it’s a way to save time, get more efficient, and offer more benefits options to their employer clients.
In this rapidly evolving landscape, it’s crucial to separate fact from fiction when it comes to partnering with third-party quoting platforms. Here, we debunk some common myths and present the realities of why carriers should embrace these platforms for a more efficient and expansive distribution strategy.
Myth 1: Working with Platforms Means Being “Spreadsheeted”
Reality: While carriers fear their plans will be reduced to a mere price comparison, the reality is that brokers already use spreadsheets to compare plans. By partnering with third-party platforms, carriers can ensure their value propositions are highlighted alongside their pricing. These platforms often have advanced features that showcase the unique benefits and differentiators of each plan, beyond just the cost. And besides, you can’t win if you’re not in the game – quoting platforms, at worst, are a way to get more visibility for your plans.
Myth 2: It’s Technically Challenging and Time-Consuming to Partner with Platforms
Reality: Integrating with third-party platforms might seem daunting, but solutions like Ideon make the process straightforward. Carriers get connected with multiple platforms through just one integration, and in many cases there’s zero technical work for the carrier. This not only saves time but also reduces the complexity and cost associated with building individual connections to each platform. Getting started with platforms isn’t nearly as challenging as carriers expect.
Myth 3: Brokers Would Rather Work Directly with Carriers
Reality: Brokers prefer the efficiency and convenience of using third-party platforms for quoting multiple carriers at once. These platforms provide a one-stop-shop experience that simplifies the quoting, comparison, proposal, and selection process. By being present on these platforms, carriers can meet brokers where they work and facilitate easier access to their products, increasing the likelihood of being included in proposals. Ultimately, it means greater opportunity for more sales.
Myth 4: Third-Party Platforms Decrease Control Over the Quoting Process
Reality: Carriers can maintain control and visibility over the quoting process even when using third-party platforms. Many platforms provide insights into who is quoting their products and allow carriers to receive detailed data back from the platform, including sold-case information. This transparency ensures carriers are not left in the dark and can continue to manage their business effectively.
Myth 5: Carriers Need Direct API Connections to Platforms for Fully Customized, Underwritten Quoting Experience.
Reality: Carriers often think that direct API connections to each platform are necessary to offer customized, underwritten quotes. However, Ideon enables carriers to provide fully customized, underwritten quoting experiences across multiple platforms without requiring individual integrations. As Hannah Thompson from Beam Benefits highlighted, API integrations allow carriers to “ingest census data, which means we can provide custom, underwritten, real-time bindable rates to these platforms.” Ideon facilitates this process through a single connection, accelerating time-to-market and ensuring a scalable and efficient way to meet the demands of brokers and employers.
Why leading carriers partner with quoting platforms
The ancillary benefits market is evolving, with third-party quoting platforms becoming integral to the distribution strategy. Brokers are increasingly relying on these platforms to quickly and efficiently quote plans from multiple carriers. As this trend continues, it’s crucial for forward-thinking carriers to engage with the platform ecosystem to stay competitive.
Partnering with these platforms offers several advantages:
- Broader Reach: Carriers can expand their distribution network and reach more brokers and employers.
- Increased Efficiency: The digital quoting process is faster and more efficient than traditional methods.
- Enhanced Customization: For highly advanced carriers that are exploring quoting APIs — some even with custom underwriting functionality – quoting platforms provide a channel to get these modern capabilities into the market. Brokers appreciate the ease of use and comprehensive quoting capabilities, leading to stronger relationships.
Getting Started
The best carriers are already working with third-party platforms and optimizing their workflows to enable efficient quoting. Brokers want it, the ecosystem is growing, and the results speak for themselves.
Something to keep in mind: Platforms are eager for more carrier partnerships without the need for direct integrations. Ideon is a powerful option to facilitate these partnerships.
Carriers, through Ideon, can work with numerous platforms and maintain visibility into their quoting activity. And in many cases, carriers are even receiving sold-case information back from Ideon, creating a seamless experience from quote to proposal to sold case to enrollment.
The bottom line: There’s a fast, easy way for carriers to make this shift, ensuring they remain competitive in an evolving market. Embrace the transformation and join the growing number of carriers benefiting from third-party quoting platforms.
Expand your reach to today’s leading quoting platforms, without any technical development. Carriers can reach out to Ideon here to get started.
Healthee Partners with Ideon to Transform Employee Health Benefits with Enhanced Provider Search Experience
Healthee and Ideon have partnered to reshape employee health benefits. By integrating Ideon’s provider data API with Healthee’s AI-powered platform, this collaboration enhances efficiency and real-time access to healthcare provider information.
New York, NY, August 5, 2024 — Healthee, a leading innovator in employee health benefits solutions, is excited to announce its strategic partnership with Ideon, the leader in data solutions for the health insurance and benefits industry. This collaboration is set to transform the way employees navigate their healthcare needs, delivering unparalleled efficiency and streamlined provider search capabilities.
At the core of Healthee’s offerings is its AI-powered platform, designed to simplify healthcare management for employees. By integrating Ideon’s cutting-edge API technology, Healthee will further enhance its ability to provide real-time, personalized health benefits information. This partnership will enable employees to make informed decisions about their healthcare needs with unprecedented ease.
“We are excited to join forces with Ideon to bring a more integrated and seamless experience to our users,” said Ron Zionpour, VP of R&D of Healthee. “Our commitment has always been to provide users with the most accurate and up-to-date data sourced from multiple highly trusted providers. By leveraging Ideon’s API platform, we can enhance our ability to deliver robust, real-time health benefits information, making healthcare navigation and provider discovery more efficient and less time-consuming.”
Ideon is renowned for empowering digital health and healthcare navigation platforms with the industry’s most accurate data on providers and network participation. By partnering with Ideon, Healthee can provide employees with instant access to up-to-date information on their health plans, network providers, and cost estimates for medical procedures. This integration will significantly reduce the administrative burden on HR teams and improve overall employee satisfaction with their health benefits.
“We are excited to partner with Healthee, a leader in healthcare and benefits innovation,” said Steve Swad, CEO of Ideon. “Our combined technologies will streamline the care navigation experience for employees, providing them with real-time, accurate data and insights that are crucial for making informed provider decisions.”
Through this partnership, Healthee will introduce several new features powered by Ideon’s API technology, including enhancements to the provider search experience with real-time access to robust data sets and healthcare provider information. These features will help employees better navigate their healthcare journey, optimize their provider selections, and ultimately lead to improved health outcomes and cost savings.
About Ideon
Ideon is the way health insurance carriers and employee benefits providers connect with technology partners to deliver seamless consumer experiences at every stage of the member journey. Ideon serves as the infrastructure simplifying the exchange of quoting, provider, and enrollment data between carriers and the technology partners, so they can deliver health and employee benefits to hundreds of millions of Americans everyday. Ideon transmits billions of data points between InsurTechs and insurance carriers, powering an amazing benefits experience for all. To learn more, please visit: www.ideonapi.com.
About Healthee
Healthee, a pioneering health tech company, is dedicated to reshaping the way employees interact with their healthcare. Harnessing the dynamic fusion of innovation and cutting-edge AI technology, Healthee strives to empower individuals in making informed decisions about their well-being, ultimately enhancing care outcomes and reducing overhead for all parties. For additional details, please visit Healthee.co or connect with us on Twitter, Facebook, LinkedIn, Instagram, and Youtube.
Provider-network data is revolutionizing health & benefits technology
Summary
Provider-network data is powering today’s most innovative health and benefits technology, from healthcare navigation and provider search apps to telehealth and analytics platforms.
Provider-network data is the backbone of today’s most advanced technology platforms and apps in the health and benefits space. From doctor search apps to appointment scheduling and healthcare analytics, countless digital experiences rely on this critical information to serve the needs of tech-savvy consumers and the modern workforce.
In this blog, we’ll explore five ways health and benefits innovators are leveraging provider-network data to deliver exceptional user experiences.
But first, what exactly is provider-network data?
At its core, provider-network data encompasses detailed information about doctors, facilities, hospitals, and other healthcare providers, along with the insurance networks they participate in. A comprehensive dataset includes:
- Name of provider
- NPI number
- Provider specialty
- Address of the provider
- Phone number
- Insurance networks in which the provider participates
- Hospital and physician group affiliations
- Whether the provider is accepting new patients
While this information is often available through insurance carriers’ provider directories, platforms can now access it more efficiently, from a single source like Ideon. Offering this data via an API makes it easier for technology companies to integrate it into their products.
As access to provider data has expanded, there’s been a surge in innovation within the digital health, healthcare navigation, and benefits technology industries. At Ideon, we’ve witnessed firsthand where this innovation is thriving, all rooted in better availability of high-quality data.
Below are five types of companies where provider data is driving significant advancements.
Healthcare and Benefits Navigation
Healthcare navigation platforms like HealthJoy, Healthee, and Castlight Health streamline understanding and utilizing employee health benefits. They offer easy access to insurance details, compare benefits options, and provide personalized recommendations, empowering employees to make informed healthcare decisions.
A standout feature is integrating provider-network data, simplifying the process of finding in-network doctors. Advanced tools like AI-driven chatbots use data to guide employees to quality, cost-efficient providers.
Plan Selection and Enrollment Support
Platforms like PlanSource and Benefitfocus simplify selecting health plans and benefits, making the enrollment process efficient and more informed for employees. These platforms allow users to compare health plans and benefits, helping them choose the best coverage based on clear, concise information.
Provider-network data plays a crucial role by guiding employees toward plans that include their preferred doctors, ensuring continuity of care. By incorporating this data, these platforms offer personalized plan recommendations tailored to employees’ healthcare needs.
Telehealth
Telehealth platforms such as Teladoc and Amwell have transformed healthcare access by enabling remote consultations with doctors and specialists. These platforms offer a convenient way to receive medical care via video calls, phone calls, or messaging, reducing the need for in-person visits and making healthcare more accessible.
Integrating provider-network data ensures users can consult with doctors covered by their insurance, avoiding unexpected costs and facilitating seamless care. And, if a referral to a hospital or specialist is needed, the telehealth platform directs care to in-network options.
Provider Search
Provider search apps like Zocdoc and Sesame are essential for finding and booking appointments with in-network healthcare providers. These user-friendly apps allow users to search for doctors by specialty, location, and availability, offering detailed provider information, including patient reviews and ratings.
For these platforms, provider-network data helps users find doctors who accept their insurance. This saves time and eliminates the frustration of out-of-network surprises, providing personalized search results.
Healthcare Analytics
Healthcare analytics platforms like Clarify Health offer crucial insights for better decision-making and health outcomes. By analyzing numerous healthcare datasets, these platforms empower health plans and other organizations to identify trends, predict outcomes, enhance care quality, reduce medical spend, and build the best networks.
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Provider-network data is the foundational element driving all these user experiences, ensuring that platforms can deliver accurate and personalized information. Today, platforms no longer need to work with individual carriers or aggregate data from multiple sources. Instead, they can leverage partners like Ideon, which deliver provider-network data via a standard API. This streamlined access to up-to-date provider information enhances the ability of these platforms to deliver modern experiences to users.
Test the industry’s most accurate provider-network data
Digital health, healthcare navigation, and analytics platforms rely on Ideon for the highest quality provider-network data. Download a data sample below.