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ProviderTrust Case Study

Post-Acute Health System

The following case study is a high-level look into the onboarding process of a ProviderTrust customer, one of the largest post-acute systems in the United States, with well over 75,000 employees. ProviderTrust was engaged to help solve their challenges related to employee exclusion and license monitoring.

Summary

ProviderTrust initially focused on license verification and exclusion monitoring to help our client get a clear picture of the current status of their overall compliance. Given the client’s volume of acquisitions in recent years and current decentralized processes In this area it was important to start with an accurate picture.

Working with our clients’ existing Human Resource Information System (HRIS), ProviderTrust was able to capture the required employee demographic information which allowed ProviderTrust to conduct license verification at the primary source state licensing boards as well as conduct OIG and state Medicaid exclusion list searches. We were able to complete the initial exclusion matching/ verification process of over 92% of the employees within 24 hours. The initial exclusion matching process determined whether or not any existing employee was, or is, excluded by a federal or state exclusion authority (OIG, SAM and available state Medicaid exclusion agency). The remaining 8% of possible name matches were resolved within thirty (30) days.

This case study demonstrates the strength of ProviderTrust’s Passport® solutions’ proprietary DataIQ. With a core focus of managing, augmenting, and organizing large amounts of employee data to ensure 100% compliance. We make sure all your employees are properly licensed and exclusion free.

About the Client

85,000+
employees
45+
states with facilities
Services include
  • Skilled nursing and rehab
  • Long-term acute care hospitals
  • Sub-acute units
  • Home health
  • Hospice and non-medical home care sites
  • Inpatient rehab units (hospital-based)
  • Rehab service

The Challenge

Prior to onboarding with the ProviderTrust Passport® product, our client used a different third-party service for exclusion monitoring and corporate HR/Compliance did their best to monitor a decentralized license capture and verification process. In addition, the company had grown into new verticals, business lines and completed major acquisitions and thus did not have a defined, uniform set of qualifications needed for each position, in each state. After recognizing a need for change, our client vetted vendors, and ultimately selected ProviderTrust. We came together to set some clear, definitive goals for our journey ahead.

Partnership Goals

  • Complete ongoing license and exclusion monitoring through an automated, easy-to-use application, providing exact matches to reduce the risk and inefficiencies within their current process.
  • Eliminate the challenge that our client faced in manually finding all available information within all of the licensing boards across the country. And manually verifying each licensed professional.
  • Identify and correct employee license information including license number, expiration date and issuing state or national certification boards currently maintained within their internal data repositories.
  • Identify and correct any inconsistencies with employee demographic information such as name, address or SSN preventing accurate monitoring.
  • Create an authoritative data source where licenses can be stored and updated in real-time to prevent an unlicensed or uncertified person from working within their organization.

How We Helped

  • Conducted nationwide federal and state exclusion searches. With any employee population of this size, there will, statistically, be exclusions that are found and need to be resolved. The previous vendor found very few potential matches which would cause concern as to whether or not the search algorithm was sufficiently robust. This can be due to a limited matching algorithm or lack of data augmentation to find existing records.
  • Implemented our proprietary DataIQ protocol to determine the completeness of the employee demographics.
  • Provided client with updated employee demographic information including, but not limited to, name changes, address changes and inaccurate social security numbers.
  • Conducted license verification on all licensed employees at the primary source to create an accurate and complete license dataset for the client.

 Results

Here's what ProviderTrust discovered

Exclusion Search

12 exclusions

for 85,805 employees onboarded

$1.2 million

minimum fines faced by client if exclusions had not been found
(based on industry average)

License Verification

ProviderTrust conducted exhaustive database searching to confirm all licenses provided by our Client. When inaccurate information was provided we attempted to find additional information on all employees, in an effort to validate current licenses. The License Verification Process was conducted by line of business to help identify any possible process changes which may need to be implemented going forward to reduce the risk of ineffective pre-hire information gathering.

29.9% of licenses had issues

of client's 21,000 active licenses

Some of these issues included:
511 licenses with names provided by client that did not match licensure board information
294 expired licenses
4 probationary licenses

Final Review

In addition to solving and providing a reliable, compliant and updated licensed workforce solution, ProviderTrust was able to bring our client closer to their goal of 100% compliance with its licensed population. We were able to create a “clean slate” for the Client to begin their ongoing monitoring solution with us. They are now confident that they are aware of any license and/or exclusion concerns and can quickly remediate as needed. All of these findings were aggregated and displayed to the client through our robust compliance dashboard. Access to our dashboard is role-based so it allows users throughout the organization to see only the “right” information and helps them focus on their highest priority issues.

The ProviderTrust compliance dashboard allows each location to monitor ongoing compliance and is alerted any time there is an exclusion or license issue. The corporate dashboard also allows executive management to have, for the first time, full transparency across the entire organization.

“We can now do what we have been unable to do, with 100% confidence, when it comes to our workforce compliance. I can now sleep at night knowing that we are providing the best care with the most qualified providers”.

Senior Director, Compliance

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