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V12 PDE is a robust and scalable platform that consolidates multiple provider data sources (both internal and external) such as CMS data, purchased or subscribed data, to build a complete up-to-date and accurate provider profile. This profile can be used for both in and out of network providers for ranking, querying and network adequacy, as well as for OIG compliance checking used in the credentialing process.
Pre-mapped connectors for popular data sources and tested processes for Managed Care Organizations, Integrated Physician Networks, Accountable Care Organizations (MCOs, IPNs, ACOs), Health Systems and more. Organizations need flexibility and speed to market. V12 PDE is the answer!
National Plan and Provider Enumeration System (NPPES)
CAQH ProView
Custom API-based integrations and ongoing data file transfers are also available in the V12 Provider Data Engine application. Common additional data source integrations include: Claims/Adjudication Systems, Provider Directory Applications, Electronic Data Warehouses, State Registries (Medicaid lists), Provider Rosters, Network Adequacy Applications, etc.
Stay up to date on provider demographic and network data changes based upon your preferences. The V12 Provider Data Engine application puts the power back in your hands and gives you the ability to decide which data sources are most accurate in specific scenarios. The end result: a highly customized provider directory “engine” capable of weighting data based upon your workflow logic and scoring domains. At Virsys12, we believe tools like the V12 PDE solution will help payers and providers alike adhere to ever changing provider data accuracy mandates such as the CAA.
Data Age
Source System Trust
Completeness of Data
Data Derivation
Data Consensus
Detail Significance
Provider directory maintenance is not always black and white. With the V12 PDE application, you get to decide between a fully automated solution and certain outlier scenarios that may require internal review or an approval process. Both approaches are accounted for and encouraged by our users. The V12 Provider Data Engine application features a Salesforce user interface component to quickly make provider data update decisions in a queue-based fashion with the option to trigger approval cases for further review. Irrespective of the approach, the V12 PDE application is designed to reduce manual input and improve provider data accuracy with automated workflows, all while keeping the provider directory as accurate as possible.
Improperly-paid claims
Claims adjustments
Lengthy, expensive recoupment
OIG exclusions go unchecked
Non-compliance
Costly fines up to $25k/incident
Perceived as deception
Non-compliance
Costly fines
Disconnected provider data
Inability to manage costs narrow
Ready to learn more about V12 PDE? The breadth and functionality of V12 PDE spans far beyond one page of information, but this quick, in-depth overview will help you start digging in.
Whether you have a few quick questions, want a full demo of V12 PDE or find yourself somewhere in between, we’re here to help.
Can’t wait? Call us at (615) 800-6768.
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