Conduent Expands Healthcare Payer Offering with AI-Powered Provider Data Management Solution for Health Plans

Conduent has introduced a new solution - Provider Data Management (PDM) - that addresses the needs of health insurance companies. The solution offers a centralized and real-time data source to ensure the accuracy of doctors' directories. By leveraging advanced AI and analytics, the PDM solution collects, validates, and communicates essential data points related to a doctor's network participation, demographic details, and more.

The PDM solution allows health insurance companies to enhance claims auto-adjudication rates by reducing common data errors like incorrect addresses and specialty information. Moreover, the solution improves doctor and member satisfaction by providing accurate and up-to-date information, helping patients avoid unexpected bills, and connecting with the appropriate in-network healthcare providers.

“Health insurance companies struggle to maintain, verify and update their network directories. Our new innovative AI-driven data management solution eliminates complexity with a single source of truth to reduce incorrect claims payments, negative member ratings and unsatisfied doctors,” said Randall King, President, Commercial Solutions, Conduent.

To comply with the No Surprises Act, health insurance companies need to update their directories promptly after any changes to doctor information to avoid penalties. However, many companies still rely on manual and resource-intensive processes, which increases the risk of non-compliance. Conduent's Provider Data Management (PDM) solution addresses this challenge by leveraging AI and automation to facilitate daily updates of crucial information. Additionally, Conduent's solution includes a team of call center professionals who proactively contact healthcare providers to verify and complete any missing or inaccurate data.

Conduent's Provider Data Management (PDM) solution is the latest offering in its comprehensive suite of Healthcare Payer solutions, designed to streamline health plan administration. With a focus on member enrollment, claims management, compliance, cost optimization, and operational efficiency, Conduent has been supporting health insurance companies in these areas for over four decades.

Elsewhere, Conduent has recently released a research report stating that to enhance employee satisfaction and engagement, Human Resource departments need to utilize a combination of digital and human interactions.