As the Payer market continues to evolve and the complexities continue to grow, so does the demand for high quality data around providers at locations and accurate credentials. Despite these market dynamics, most of the state and federal source data that payers require to stay compliant with legislation remains stagnant, with quality levels that cause more challenges for the industry.

Therefore, the LexisNexis Risk Solutions® strategy must contain continuous validation and improvements of data, strategic investments and innovation to drive results and improve outcomes for consumers. We are committed to working on behalf of our customers to help meet the data challenges they face every day. We rigorously check that our data helps meet our customer needs across multiple dimensions of quality.

Evaluating New Approaches to High Quality Data

To ensure we are continually hitting high measures of quality and providing timely results to our customers, we have recently acquired and released to production a new source of data improving our ability to capture providers at locations with Tax ID Number. This will make a positive impact in our ability to not only identify new locations for providers, but also improve our ability to confidently say a provider is or is not at a location, particularly critical where a single TIN has multiple practice locations.

In addition, we understand it is critical for our customers to have the correct view of a provider regarding their credentialing information. National Provider Identifier, License and DEA all need to be brought together so that the information consumers interact with directly (e.g., status, specialties, names, and certifications) is more accurate.

While traditional methodologies of linking data such as rules-based linking have done a very good job at bringing healthcare sources together, our commitment is to continually evaluate new and different tools/approaches to increase quality and drive results for customers.

Statistically Based Linking to Reduce Over- and Underlinking

Over the coming months, LexisNexis Risk Solutions will begin to apply statistical linking techniques to our data to maintain existing crosswalks and create new crosswalks of our high quality data.

The statistically based linking process is dynamic, which means that identity profiles are continuously validated and updated as new data sets and records are ingested. It also uses an iterative approach to gather and compare all the data about a specific entity and validates the profiles. This approach has proven in multiple healthcare markets to reduce underlinks and overlinks while maintaining greater integrity of crosswalks.

As market complexities continue to increase, so too does the our commitment to quality. These examples are the highlights of many quality improvement activities currently in progress. These activities are market-focused, customer-driven and a core value of our organization.

Learn more about what we do as a leading healthcare solutions provider.