Payers manage various applications related to network management, provider credentialing, contracting, care delivery, claims processing, and prior authorizations. These applications are typically used by various operational departments and staff and maintained by multiple IT resources. Unfortunately, this often results in fragmented data with limited quality control and questionable sources of truth. As a result, payers face challenges in maintaining accurate provider information, impacting claims payment, care gap closure, and provider attribution.
1Clearsense™ Data Analytics & Interoperability Platform
Provider Data and Network Management
Establish a Unified Source of Truth for Provider Data
Inaccurate and inconsistent provider data also affects members who struggle to find suitable providers or schedule services. In response to these common challenges, CMS has introduced measures such as timely provider roster updates and the implementation of provider directory APIs as part of the 2026 Proposed Rule, emphasizing the importance of accurate and up-to-date provider information.
The Clearsense Approach
1Clearsense, an all-in-one healthcare data platform, aggregates data from various sources and is powered by the Clearsense Healthcare Data Model. This model offers pre-built integrations and accelerators to rapidly implement connections, mapping, and data quality rules, ensuring data lineage and traceability. With payer and provider data residing within the common healthcare data model, organizations can determine the source of truth and assign trust rules. Collaborating with organizations, Clearsense establishes granular data access policies and assigns security controls. Accessible data can be seamlessly utilized in 1Clearsense analytics, outgoing integrations, and customized applications through 1Clearsense's bring-your-own-tool (BYOT) capabilities.
How Clearsense Helps
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Aggregate disparate data sources into the Clearsense Healthcare Data Model and bring transparency and consistency to the data.
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Facilitate cross-departmental collaboration on provider data so payers can reliably create business rules, define sources of truth and access policies, and ensure appropriate data usage.
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Continuously monitor changes to data and data quality to produce notifications and alerts, enabling payers and providers to take action on updating provider demographics, credentialing, network assignment, point of care alerts, and other critical information.
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Improve the accuracy of provider contracting, performance, and reimbursement.
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Enable API-based data sharing and integration in compliance with CMS 2026 Proposed Rule.
Provider Data and Network
Management Benefits
Reduce manual intervention and duplicate efforts of staff to update disparate applications.
Increase speed and accuracy of claims adjudication and payment.
Improve network segmentation and empower strategic decisions on network growth.
Validate provider credentialing and attribution.
Boost care gap closure and provider performance reporting accuracy.
Why Payers and Payviders Choose Clearsense
Data Aggregator
Facilitating the seamless and transparent exchange of information between healthcare providers and payers in compliance with NCQA DAV certification.
Robust Interoperability
HL7 and FHIR-enabled platform supporting common healthcare messages and transaction types, including CCD, ADT messages, and claims, following healthcare standards, including USCDI and EDI X12.
Velocity and Agility
Leveraging the Clearsense Healthcare Data Model, 1Clearsense scales to accommodate your organizational growth and rapidly responds to market demands with unmatched velocity.
