Defining the Provider Data Dilemma

Prepared for CAQH

Healthcare provider data forms the foundation of many important processes in the nation’s healthcare system. This information is necessary to conduct a number of essential functions, such as referring a patient to a specialist, paying insurance claims, determining provider sanctions and credentialing providers. Obtaining accurate, timely provider data has long been an issue across the industry.

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In a new white paper, titled “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration,” developed jointly with CAQH, Manatt Health emphasizes the importance of full industry collaboration in developing an effective approach to collecting, maintaining and disseminating accurate, high-quality data from healthcare providers. While the job of collecting and maintaining provider data may appear straightforward, the white paper details the complexities of this process and how increased industry collaboration can serve as a remedy. Challenges include a lack of reliable sources of data, standard definitions of providers, quality benchmarks and accountability measures.

This paper helped to inform the discussion when healthcare industry leaders gathered in Washington on Sept. 29 at the 2016 Provider Data Summit, hosted by CAQH, to explore the topic of provider data challenges and ways to overcome them.