Best Provider Data Management (PDM) Software for Mid Size Business

CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available.

Collaboration for patient care requires constant connectivity. It is important to simplify how you exchange this information with your payers. Availity makes it easy for payers to work together, from the initial check of a patient’s eligibility to the final resolution of your reimbursement. You need quick and easy access to information about your health plan. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity Essentials Pro, a premium, all-payer option, is also available to providers by Availity. Essentials Pro can improve revenue cycle performance, reduce claim rejections, and help to capture patient payments. So you can concentrate on patient care, Availity will remain your trusted source for payer information. Providers can integrate HIPAA transactions into their PMS through our electronic data interchange (EDI), clearinghouse, and API products.

Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more.

Certify provides API-first licensing, credentialing, and enrollment to payors and health systems as well as rapidly-growing digital health companies. We provide insights and enable organizations to achieve high performance. Our one-click credentialing solution helps you build best-in-class provider network. Automated, real-time NCQA-compliant credentialing for scaling provider networks. Automated monitoring to ensure compliance of provider networks. We take the guesswork and paperwork out of licensing so you can scale to new markets seamlessly. You can join the network to get reimbursed quicker so you can get back on your feet. Streamlined processes to cross-state licensure for all license categories in all 50 US states. Streamlined enrollment for payers to allow providers to be in-network in new market. Our dashboards allow you to track enrollment progress. Our best-in-class method will clean, normalize, or enhance your provider data.

CORE brings together the industry to accelerate automation and develop processes that streamline healthcare services for patients, health plans and providers. CAQH, a healthcare organization's trusted source of member and provider data, helps reduce costs, improve payment accuracy, and transform business processes. In an ever-changing healthcare landscape, it is vital to improve payment and claim processing systems. The new and updated CAQH CORE operating rules represent a significant advance in our ongoing efforts to improve efficiency.

Our automated solutions will give you back hours of your day, and millions in your pocket. You can access the key players - providers, payers and partners - as well as the real-time accurate data that you need to ensure that care delivery is never missed. We handle all the complicated connections across thousands payers. Here you will find all the information you need for a fast and easy registration to any payer. Cloud computing has never looked so good. Central command to manage and store provider data in real time, connected everywhere. Provider verification made simple. Our platform will process your request quickly.

Innovit's iICE Training programs are designed to provide relevant knowledge and skills for your employees. You can be sure that your team will continue to improve their systems and processes for the sustainable management master data by incorporating 'best practices' in product information management. Innovit is a global provider of solutions that specializes in MDM (Master Data Management), PIM [Product Information Management], GDSN (Global Data Synchronization), UDI Compliance, Unique Device Identification (Unique Device Identification), and NPI Workflow Automated software.

Model N is an end-to-end platform that empowers companies to maximize their revenue by transforming Sales, Marketing, Channels and Finance. Model N's revenue management solutions can help you maximize your revenue by turning tactical, siloed activities into strategic, end-to-end revenue processes using automation and intelligence. Revenue Cloud bridges the gap between back-office and front-office activities, providing a single system of record for all revenue execution. Customers can easily set up and quote complex products, quickly reach terms on complex contracts, have better channel data, which allows for visibility into channels and efficient management of incentive programs, avoiding overpayments. Model N Rebate Management allows you to better engage your channels and maximize revenue.

Health systems can match patients to the right providers, optimize patient access, and manage data with industry-leading solutions. Our provider search and schedule solutions, built on the Kyruus data management platform, enable health systems to optimize matching between patients and providers; boost patient acquisition and convert; and deliver a consistently positive patient experience at key points of entry. Create a digital presence that is unique with a modern access experience for patients. This allows them to easily find the best care options and book online. By equipping your agents with the necessary technology, you can connect consumers with the best providers via your call center. Providers and staff will be able to see the providers in your network, and patients can leave their appointment knowing that the next one is already booked.

The burden of CMS and state regulations in the health care industry creates challenges for time and money. Health plan members communicate with compliance directors every day, despite the fact that outdated processes and anxiety about not meeting regulatory compliance are common. It is time to centralize and have control over your organization's compliance program, and the entire process of creating material. CodySoft®, a web-based suite of software products, is designed for health plans and their complex environments. Project management of provider and member marketing materials is more efficient and cost-effective. Increased accuracy and reduced regulatory compliance risk It is easy to manage investigation issues. Access your dashboard online via a secure portal without any IT integration. You can easily generate reports for regulatory audits or metrics tracking. You can see real-time updates.

HealthEC's best platform for population health management, which includes our CareConnect™, and our analytics module 3D Analytics™, is designed to improve quality of care and patient experience and overcome the most difficult data challenges in the healthcare industry. A universal data warehouse that contains normalized claims, clinical, SDoH, and other data from all sources will help you conquer system chaos. CMS certified for reuse. Integrate, customizable care plans, decision support tools, and robust care management support can eliminate workflow disruption. Integrate community resources and address social determinants of healthcare to provide patient-centric care. Clear dashboards or at point of care provide actionable insights that inform strategies at the provider, provider, practice, organizational, and patient levels. Enhanced MCO performance reviews, compliance with the CMS interoperability rules.

Build the interoperability solution you need. Rhapsody is a flexible toolbox which allows your team to adapt to any modern environment. Rhapsody helps you provide the highest level service by ensuring healthcare data flows where, when and how your unique environment requires. Create flexible solutions for every connection requirement. Streamline workflows using a solution that's infinitely configurable, and specifically designed for healthcare. Create intricate integrations using a robust toolkit, which has been tested around the world. The platform has customers in 36 different countries. Create FHIR interfaces that are cutting edge with ease and simplicity using REST and FHIR specific JSON. Security is a primary concern, and is built into the entire product. This is to protect any protected health information that passes through the engine.

symplr's provider credentialing software creates a single source for data on providers, reduces turnaround times and shortens revenue cycle, all while prioritizing the safety of patients. Symplr's Provider Credentialing Software makes data collection, secure access, report generation, and ongoing compliance easier for providers, credentialing personnel, and internal approval panels. Our customers report a reduction of 20% in credentialing timelines and a 50% reduction in meetings with committees. In one automated, user friendly hub, you can collect, verify, store and share documents and data related to the provider lifecycle. This will save time and reduce costs. You can easily enroll payers with providers and track applications step-bystep using the built-in module. Automate the collection of data from hundreds primary sources, including DEA, SAM and NPDB.

A unified, automated solution for provider data can help you save money, eliminate data silos and provide better outcomes for your members. symplr pays provides a unified source of truth that is always reconciled with primary sources. It improves data access, transparency, and quality. It also eliminates the need for multiple requests for information and reduces frustration among providers. Payers can use symplr as the enterprise-wide hub to feed accurate and timely information to downstream systems by using symplr as the enterprise data hub. Our end-to-end, highly configurable provider data management solution handles all pre-contract and contract renewal negotiations. Standardize and streamline contracting processes while capturing contract information such as sentinel event, trigger dates and configuration efforts. The unique design of symplrPayer allows your organization's contracting and credentials to be consolidated.

Verisys has been credentialing events for more than 2 million healthcare organizations in the United States annually, for over 30 years. Our provider credentialing service will keep you compliant. Credentialing is a complex task for health plans, health systems, and hospitals. Physicians may be licensed in more than one state and provide telehealth across state borders. This requires licensing verification with each state board, and compliance with the unique regulations of that state. Due to the fact that physicians may have the same maiden name, alias name, nickname, or abbreviated name, identity matching can be difficult. To get an accurate picture, every physician must be screened and their credentials checked against thousands of primary sources. We can assist you with anything from a simple search for provider credentials to implementing an end-to-end credentialing system.

Our platform provides consistency, continuity and scalability throughout our integrated portfolio. This allows our customers to improve operational efficiencies, decision-making and patient outcomes, while enabling innovation in our evolving healthcare system. Change Healthcare's platform, which combines innovative data and analytics with patient engagement and collaboration features, helps payers and providers optimize workflows, get the right information when they need it, and provide the safest, most clinically appropriate healthcare. We facilitate data interoperability and access to data to support CMS patient interoperability and access rules. We also enable real-time clinical document access to better manage risk adjustments, improve HEDIS score, and support accurate payment with faster adjudication.

Accelerate payment and reduce administrative burdens. Our claims management solutions, which have a network of 8,000+ payers and a long-standing partnership with 650+ practice managers, can lead to fewer pending cases and less manual intervention. Transmit professional, institutional dental, workers compensation, and other claims quickly and accurately for fast reimbursement. Provide a simple and seamless financial experience to meet the shift towards healthcare consumerism. Our patient engagement solutions enable you to have informed discussions about eligibility and financial responsibility, while reducing obstacles that could impact patient outcomes.

SKYGEN’s Provider Data Management is a solution on-demand that helps healthcare payers improve provider network management. PDM improves payers' abilities to build effective provider networks, improves member and provider satisfaction, and lowers administration costs. It's an intelligent solution that helps payers meet the needs of today’s tech-savvy healthcare constituents. Reduced contract acquisition costs through fast, efficient and paperless provider recruitment, as well as supplemental network rental. Online credentialing reduces credentialing costs while improving provider satisfaction. Automating provider self-verification, and ensuring accurate provider data for online directories, will eliminate expensive outreach. SKYGEN provides dental and vision connectivity services that empower clients to confidently move into the future.