Healthcare Data Management Software with ProviderLenz

Eliminate the Burden on Providers

The problem of inaccurate provider data haunts health plans and health systems everywhere because the information is decentralized, lacking common oversight. ProviderLenz solves this problem as a technology-enabled solution that taps into all known, but unlinked streams of provider data to, first and foremost, curate accurate online directories in real-time.

By applying big data and AI disciplines, ProviderLenz virtually eliminates the burden on providers while dramatically improving provider data accuracy and completeness for all operational areas within a health plan or system that rely on it.

ProviderLenz also automates the CMS-required process of surveying a health plan's contracted providers each quarter to update information.

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    1. First outreach is conducted via email

    2. Followed by eFax if the email was unsuccessful

    3. Call center contact is reserved as a last resort

    1. First outreach is conducted via email

    2. Followed by eFax if the email was unsuccessful

    3. Call center contact is reserved as a last resort

    Financial benefits aside, accurate provider data yields other key benefits:

    Minimize provider abrasion

    Ensure compliance

    Increase member satisfaction

    ProviderLenz Use Cases

    Select a hexagon on our interactive graphic below to learn more about our healthcare data management system:

    ProviderLenz Use Cases Graphic
    Public Datasets

    These primarily include national and state-based data from government agencies responsible for medical licensing, clinical practice oversight, and dispensing controlled substances; such as NPPES, DEA, and State Medical Licensing Boards.

    Encounter Reporting

    Provider data errors are a leading cause of Encounter Data and EDGE Submission rejections. Excessive disallowed or rejected encounters can cause revenue leakage, which is easily avoided with ProviderLenz.

    Network Adequacy

    Inaccurate provider data can invalidate Network Adequacy compliance and result in sanctions. Network Adequacy monitoring, reporting, and intervention are built-in features of ProviderLenz.

    Care Management

    ProviderLenz keeps the Care Management platform continuously up to date on changes affecting all network providers. Care Managers can also input changes in provider details that they observe in the course of their interactions.

    Private Datasets

    These include data gathered and curated by private companies serving both healthcare and other industries with complementary data needs; such as telecommunications, credit-rating and monitoring, mapping and geo-coding, etc.

    Risk Analytics

    Many false positives and false negatives for provider/member combinations can be caused by bad provider data. The results include a missed chart, an upset provider office staff, and unnecessary expense.

    Claims Adjudication

    Faulty provider data is the reason that 10% of auto-adjudicated claims are rejected and require manual processing. Provider data errors are also to blame for 15% of provider claim payment appeals.


    Contracting staff normally tasked with keeping up-to-date information on their assigned network providers are automatically kept abreast of ever-changing demographics and other details by ProviderLenz.

    Shared Savings Reconciliation

    Always accurate provider data from ProviderLenz ensures the most accurate reconciliation of every provider’s eligibility for shared savings payments under ‘value-based’ contract provisions.

    Client Datasets

    These include information from various high-volume management information systems within health plan and health systems such as claims, care management, and provider contracting. We prefer to receive blinded data.

    Quality Metrics

    Bad provider data going into critical quality analytics can result in false denominator inclusion and no matching chart to validate the numerator. This results in negative impact to quality measure performance and revenue.

    Provider Directory

    A perpetual subject of member complaints, inaccurate provider directories are under more scrutiny than ever. ProviderLenz sets the new standard by providing continuous updates in real-time to all member-facing access points to the provider directory.

    Practice Analytics

    Precision provider performance analytics are only as accurate as the underlying provider data. Always accurate provider data from ProviderLenz empowers precise oversight and feedback to every provider; whether high performing or needing coaching and education.

    Ready for always accurate provider data?

    ProviderLenz Offers a New Approach to
    Healthcare Data Management