ProviderKey loads all data from approximately 100 provider networks into integrated proprietary database applications that clean and standardize the data and manage all adds, changes, and network terminations. ProviderKey then analyzes all network and claims record data, saves all new information and provides web access to updated and accurate records. Access and analysis is accurate even if submitted data contains non-standard data sets, incorrect changes, out-of-date addresses, billing locations or other data errors, alternative name spellings, and new provider identification information.

Data sets include physicians, hospitals, dentists, chiropractors, nurses, physician groups, laboratories, medical equipment providers, pharmacies, hospital affiliations, ancillary providers, provider network affiliations, service and business addresses and related phone numbers. All providers are grouped into one or more categories – specialties and subspecialties. Specialties are cross-referenced among many schemas that allow for retrieval with indexes that span from 20 to over 850 definitions. Specialty lists may be tailored to meet any requirements. ProviderKey’s interoperable data set allows information to be exchanged with different client systems even if varying proprietary formats are used.

Web-based services are offered that meet the data retrieval, record identification and analytical needs of claims administrators, health insurers, health plan members, health plan consultants, actuaries, provider networks, audit, fraud and abuse organizations, regulating agencies, healthcare analysts and researchers.

• The ProviderKey application allows clients to create a Custom Provider Network (CPN) by selecting any of the available PPO networks, geographic areas of coverage and specialties to be included.
• Plan members may be given access to any PPO or custom provider network though the Internet. Plan members’ access can be limited to plan specific contracted providers for a specific geographic area and specialty. Individual providers may be included or excluded by name, ID or any other unique client-customized parameter.
• Resolves in-network eligibility of providers for claims administration.
• Matches current and accurate provider network data to historical records in a claims system.
• Identifies providers linked to a claim, tags the claim record with a unique ID and adds specific corrected provider data elements to the claim record.
• Download a database of cleaned provider information for any PPO or CPN formatted for use by the client’s systems or other applications.
• Plan administrators or consultants may generate PPO network geographic access reports and name-matching reports of network providers to providers used by the health plan members.
• The ProviderKey database retains all historical data including erroneous and misspelled information related to current information on every provider. It offers an ideal platform for plan and regulatory auditing as well as resolving fraud and abuse issues related to claims and provider identification. Browser-based and computer-to-computer interfaces offer flexibility and high volume solutions.
• XML based infrastructure support for client-directed and specified Electronic Health Record and electronic Continuity of Care Record standards that can be read and interpreted by any EHR or EMR software application.
• Supports provider infrastructure reporting between and across all health care supply chain, care delivery and financing enterprises. Information can be sent and received seamlessly, independent of other client system operating platforms.