Managing the contracting and demographic maintenance processes of Provider and Practitioner Information

Every Payor organization struggles with the constant barrage of incoming additions, changes and deletions of Provider and Practitioner data that are submitted through multiple channels.   Many even need to be transcribed by clerks just to begin the process of updating all the systems that must be aware of the submissions: claims, plans, directories, etc.  In some cases, depending on the infrastructure, data needs to be submitted differently to multiple legacy systems to onboard a new Provider.  The review and approval workflow process of the submission can also vary widely, impact multiple departments and is typically based on the type of add/change/delete information submitted.  Allocating the review activities among staff and monitoring the status of the Provider submission is also critical from a management perspective.

A single repository for all intake and output of Provider enrollment and maintenance information will increase data accuracy, speed the update of Providers/Practitioners and eliminate the need for silos of data that cannot be cross accessed or shared.   Symfact has such a platform.  A high-level representation of the data relationships that can be supported follows:


Symfact’s solution is highly configurable to your data requirements and taxonomy, making it possible grow the application as required, as you eliminate the standalone systems that have propagated over the years to keep the legacy systems fed.

Key platform features:

  • Onboarding/Intake of new Providers, Sites and Practitioners
  • Credentialing APIs
  • Address verifications
  • Multiple addresses- Directories, Payments, Corporate, etc.
  • AI data extraction of Form submissions for efficient and accurate Add/Change/Delete processing
  • Assign review and approval tasks by department and staff workload
  • Monitor and report the progress of each submission’s workflow
  • Create feeds to Online and other Directories
  • Configurable Process management by department and business event for adds, changes and deletes of Providers, Practitioners and Locations
  • Integrated Legal Entity Management for contracting Plan/Entity
  • Full audit trail of all system activity
  • HIPAA compliant site hosting
  • Alerts and reminders automatically generated, with escalations if not addressed
  • Integrated Contract templates, Clause libraries and Contracts using MS Word
  • Contract document generation with User-defined MS Word templates and system meta data
  • Integrated eSignature for contract execution
  • Manage relationships between Providers, Practitioners and Sites
  • Embedded alerts and reminders
  • Data structure supporting relationships between Providers, Sites and Practitioners
  • Validation to NPI
  • Highly configurable platform to support your specific requirements
  • REST APIs to support legacy system interfaces
  • Role-based security to control access to data and system functions

For a further review of the platform and demonstration please contact:

Harry Angel
Managing Director, Healthcare Practice

Our Healthcare Customers

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