Six questions to ask when evaluating a provider-network data solution

Offering provider search to end users is now table stakes for healthcare navigation platforms, digital health apps, and all sorts of InsurTech companies. If a digital tool can’t deliver an intuitive experience for finding in-network doctors and hospitals—and making informed, cost-efficient healthcare choices—potential customers will look elsewhere.

What’s the one foundational element that all provider-search tools need? Provider-network data — information about doctors, hospitals, and the insurance networks they participate in. Today, rather than undertaking the herculean task of aggregating this data from various carriers and sources, tech companies can seamlessly ingest it via an API.

There are a few provider-network data solutions available in the market, but not all are created equal.

An effective solution must offer accurate, timely data and seamless integration that enables a positive end-user experience as well as money- and time-saving operational efficiencies for all stakeholders.

This means that to identify the right choice, tech companies must make some critical assessments when testing a provider-network data solution. Here are six key questions to ask (and answer) along the way.

Is the data complete?
The breadth of provider-network data can be a pivotal differentiator between a great solution and a passable one. The more complete the data—e.g., provider names, addresses, phone numbers, network IDs, languages spoken, specialties, and network tiers —the more comprehensive the results for searches will be. Robust data lets users search providers by network and/or plan, and search networks by carrier. Typical use cases include selecting a primary care provider during open enrollment, confirming that a physician referral falls within a patient’s network, and facilitating app-based scheduling of physician appointments.

Is the data accurate—and easily remedied when it isn’t?
Comprehensive data is only an edge if it’s also correct. Inaccurate data—say, regarding physician network participation, specialties, or addresses—can have a significant downstream effect, resulting in billing errors, denied claims, and the person-hours required to rectify them. A provider-network solution should also have validation capabilities and procedures to ensure that data is verified and up-to-date, not to mention meaningful measures in place to detect and reconcile discrepancies.

Is the data timely?
Even the most complete and accurate data is a bit like a fresh-baked loaf of bread: It may be delicious, but it’s going to get stale eventually. An effective provider-network solution will update data from carriers and other sources on a regular cadence, often weekly, monthly, or somewhere in between. But because each one of those carriers provides their data on their own schedule, it’s crucial that a data solution has an automated process in which it ingests, aggregates, and standardizes the data, ensuring the freshest “loaf of bread” possible.

Is the solution scalable?
Scalability should be top of mind for tech platforms seeking to aggregate data from multiple carriers — doing so without a capable provider-network data solution can be prohibitively cumbersome, requiring a separate set of integration processes for each carrier. Scalability is also critical for carriers integrating with an increasing number of benefits platforms. A scalable, flexible solution will be poised to evolve and grow along with its customers.

Does the solution have strong carrier relationships?
Established relationships with carriers is a primary differentiator for a provider-network data solution. Ideon, for example, has nearly 100 carrier relationships going back many years. We know from experience that accessing complete, timely, and accurate data is only possible when there is a relationship-based buy-in from carriers.

Is the solution secure?
Technology companies, carriers, and end users must be confident that, along with seamless and intuitive search, a provider-network data solution offers confidentiality and operational transparency when it comes to the safety and security of its network data. No product evaluation would be complete without asking: What data governance, encryption, and recovery measures are in place? What was the result of the most recent SOC 2 audit?

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The process of testing a provider-network data solution can be intense, with limited time to make a decision that will shape an organization’s ability to meet customer and end-user expectations for years. These six questions will help product leaders and data strategy decision-makers to choose the best solution for their needs, leaving more time for cost-benefit analysis and other evaluation. Interested in learning about Ideon’s provider-network API? Contact us here.