Data solutions for Accurate Medicare and Medicaid Provider Networks
Millions of children and adults in the US rely on Federal and State health programs for quality care every day. MedFax data solutions enable these Medicare, Medicaid-based entities and other agencies to accurately complete provider verification along with identifying and monitoring networks while increasing the access to needed, quality healthcare.
By aggregating demographic and sanction/exclusion data in real time, government agencies and managed care organizations are alerted to not only individual cases of fraud but are able to evaluate emerging trends and concerning patterns throughout a network.
Before TruthMD, there was little government entities could do to verify demographics and sanctions. With MedFax data solutions, agencies can see complete and integrated physician profiles, and close those loopholes without dedicating weeks or months to costly and labor-intensive manual research.
MedFax data solutions continually aggregate real-world data from more than 20,000 primary sources, creating the first, truly validated, trustworthy, actionable tool for Federal and State healthcare agencies to understand and update data on their providers from nurses to neurosurgeons, all in real time.
With constant monitoring and updates from primary, public data sources, TruthMD delivers the most accurate information needed for state and federal government-based programs based on:
For government agencies, the most valuable resource of fraud, waste and abuse (FWA) programs can be summed up in a single word: time. TruthMD’s MedFax helps by expanding and accelerating Fraud, Waste and Abuse risk awareness.
Agencies are well aware of how ineligible providers can impact their networks. The longer an ineligible provider remains in the system, the greater risk to the beneficiary, the more dollars they will be paid, and those dollars will likely be unrecoverable. In addition, the more time required to identify an FWA issue, the less likely agencies are able to stop claims from getting paid to sanctioned, excluded or fraudulent providers.
TruthMD’s MedFax provider data solutions enable government agencies to regain that ever-elusive resource of time.
MedFax data solutions are designed to meet the needs of service providers and payers. Access to accurate and real-time data is crucial to operational efficiency while government compliance increasingly focuses provider directory accuracy, adequacy and ongoing sanctions monitoring.
Foundational provider demographic information advancing directory-digital experience and improving overall claims adjudication.
The unique power of understanding the complexities of doctor relationships with their practices and facilities, increasing network analytics, addressing adequacy requirements and creating a member worthy provider panel.
Real-time provider license and exclusion records delivered “At Time” for mandated sanction monitoring, primary source verification and network management, with data historically unified under a single NPI.
Applying the MedFax distinctive dataset with proprietary algorithms to identify fraudulent claims pre-payment, identifying potential Provider issues, creating a bad actor lead generator for a health plan’s SIU.