NASCO’s Repository for Provider Data
In response to the healthcare industry’s transition from volume-based to value-based payment methodologies — as well as the major shifts within the healthcare provider market, including significant consolidation — NASCO developed PMR with capabilities that enable the consolidation of provider data within a single system.
PMR is NASCO’s repository for provider data that enables health plans to use new reimbursement programs and models that rely on tracking more complex provider information, including provider relationships, statuses, credentials and preferences. PMR also addresses the required integration needs of various surrounding systems, including membership, claims and payment systems, in support of the latest industry trends.
PMR is a mid-tier, Web-based product that provides user-friendly interfaces and integration with the NASCO Processing System for claims and membership data. It can easily accommodate provider data mapping from a health plan’s system of record, maintain payer-defined reference tables — without IT involvement — and store PMR-specific mnemonics that drive provider pricing and member cost sharing.
PMR also enables a health plan to capture a multitude of a provider’s statuses, relationships, credentials, locations, identifiers, practice details, preferences and more. And, with PMR, health plans can use provider networks and reimbursement programs to create product differentiation in order to remain competitive in the marketplace.
The adoption of PMR allows health plans to avoid the alternative of using legacy applications that are difficult to enhance and that, collectively, do not deliver the flexibility that new product designs demand. PMR was created based on extensive information gathered from multiple health plans, and as a jointly-funded product, PMR allows participating health plans to realize maximum value for their shared investment.
With the provider domain so critical to healthcare payers’ strategies — from value-based arrangements to consumerism — PMR enables health plans to effectively embrace the ongoing shift from volume to value with a comprehensive and flexible product that supports the changing provider landscape, while continuing to focus on improving operational performance.
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