Business Analysis

A Health Checkup for Your Data

Challenge

AllyAlign Health is a Medicare Advantage company that manages multiple plans across 22 states. As AllyAlign Health expanded its provider network and worked to ensure they provided beneficiaries with proper care—including specialists—they also needed to make certain their provider data was accurate, consistent, and compliant with the Centers for Medicare Services (CMS). Managing provider network data to ensure CMS compliance and making sure contact information and the number of providers meets thresholds (all while being easy to find for patients) can be a tedious task.

AllyAlign Health turned to Logic Cadence to help them understand where their data stood in terms of accuracy and potential gaps to mitigate potential risks from a CMS audit, and also to ensure they had accurate adequacy to serve their patient population well.

strategy

It takes an analytical mind to love this type of work. Thankfully at Logic Cadence, we’ve curated teams of folks who enjoy ensuring accuracy and have a meticulous eye for detail.

For AllyAlign Health’s provider network directory assessment, we enlisted our detail-focused team to begin a data cleanup process. The team interpreted and analyzed the available data to determine what was missing and to create a process to ensure more accurate collection and publishing of provider data in the future.

For health plans, agreements with healthcare providers are the lifeblood of their work. They must ensure they have accurate reimbursement rates, supporting documentation, and current provider rosters. Correct data lets them know when to add providers to their networks, gives the ability to submit claims correctly, and provides information to update contracts and more. All of these efforts directly support licensing, credentialing, and network adequacy across the states they serve.

Results

As a result of our work with AllyAlign Health, we were able to give them an accurate picture of their needs so that they no longer had to worry about what information may or may not be in their data. Our assessment provided clear next steps on which contracts to complete, upcoming contract end dates, where there might be gaps in adequacy, and other necessary information leadership needed to make informed decisions for their plan network. It also helped them to be prepared for CMS questions.

We ensured their data was up to standards and compliant with CMS rules and developed a process that would ensure more clear and accurate data in the future. AllyAlign now has an up-to-date provider network and online directory for their members. The correct information enables patients to search and find providers and specialists near them easily. It also empowered AllyAlign with the ability to scale their provider network data management processes as their business expands.

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