Achieve a Standardized Provider Database

Achieve a Standardized Provider Database

May 8, 2018

This blog post is part of a series on strategies and methods to accelerate reimbursement based on a recent webinar with VerityStream’s Dawn Anderson, Senior Consultant, and Cheryl Cisneros, Consultant.


Many organizations are merging credentialing and provider enrollment, implementing a centralized or enterprise solution to successfully improve reimbursement opportunities. Organizations merging need to understand that a well-defined provider database is necessary to support their organization’s readiness to respond to these changes and to ensure reimbursement. According to America’s Health Insurance Plans (AHIP), inaccurate provider data results in over $40 billion in additional administrative expense annually. This should be enough evidence for any organization to see that database standardization is imperative.


To achieve a standardized provider database, you must start with a collaborative and appreciative understanding of your respective teams, departments, and provider data elements. Trust must be established in order to create partnerships and maintain confidence in provider data. These elements are required to build a provider database foundation that incorporates credentialing and provider enrollment which feeds downstream to systems and departments. Here are some strategies and methods to help your organization achieve a standardized provider database to better ensure timely reimbursement:


Strategies to Standardize a Provider Database

  • Recognize that the provider database is the source of truth for your organization, all department and users.
  • Ensure all practitioner data elements in your internal and public-facing practitioner directories are true.
  • Ensure all internal information needed to provide referrals for other providers or specialties is accurate.
  • Look at regulatory body requirements to verify all professional licenses are current and malpractice insurance is up to date.
  • Be prepared to support referring providers within your database and ensure they have a current license and the ability to see Medicare and Medicaid patients.
  • Make sure your database can respond to system initiatives, such as integrating hundreds of providers from a new hospital or to integrate to provider enrollment as a part of the new acquisition.
  • Have the readiness to feed data downstream to other systems.
  • Consider utilizing master data management.


Methods to Standardize Your Provider Database

  • Work with your colleagues in respective departments to create a data dictionary that clearly describes how the data is going to be defined so that everyone has a clear understanding of terms.
  • Only allow a single port of entry for completing changes.
  • Create policies and procedures that are reviewed on an annual basis and agree upon who owns the changes.
  • Use a system administrator to oversee database security and permissions and to ensure the following: the privacy of confidential practitioner data is maintained, those who are entering data are entering it into the database properly, and those who are using the database are only accessing the correct data.
  • Decide on an approval process for table changes to ensure that unnecessary or redundant data is not added to tables.
  • Notify those who you feed data to downstream of any revised data standards.
  • Develop quality mechanisms to ensure database integrity.
  • Audit new applicants and reappointments for opportunities where data may need to be scrubbed.