LexisNexis Provider Integrity Scan vs. Converge

In order to address potential risks, the Centers for Medicare and Medicaid Services (CMS) have established guidelines aimed at validating their networks. The significant influence of risk assessment processes on Pharmacy Benefit Managers (PBMs) has led to an unprecedented demand for accurate and actionable insights. The LexisNexis Provider Integrity Scan simplifies a variety of provider verification tasks and maintains continuous oversight by cross-referencing a multitude of files and lists, while additionally providing automatic notifications for various high-risk indicators. This tool excels in screening and validating providers both prior to and after enrollment, effectively working to detect and prevent criminal activities in the sector. By identifying potentially fraudulent providers and entities associated with health programs, the LexisNexis Provider Integrity Scan contributes to cost reduction for health care payers and PBMs. Furthermore, our cutting-edge solution enables users to perform multiple searches and access vital information, thereby improving their operational efficiency and security. This comprehensive strategy not only protects the integrity of health care programs but also cultivates a more trustworthy healthcare landscape, ultimately benefiting patients and providers alike.

Comprehensive solutions for credentialing, privileging, and performance oversight transform compliance from a simple administrative task into a source of actionable insights. This proactive safety approach goes further than merely reacting to incidents, aiming for a holistic strategy that merges data on safety, risk, and quality. By exchanging risk-related information, organizations can glean actionable insights, empowering proactive decisions focused on achieving zero harm. Converge integrates powerful analytics and business intelligence, providing essential safety data and tools that are readily accessible. Users can conveniently log near misses, incidents, feedback, or recognitions directly through the EHR system. Working closely with your implementation manager is vital for establishing the best timeline, team structure, and project scope that aligns with your organization’s unique requirements. This framework incorporates Mortality Review, Safety Rounds, and Patient Launch to pinpoint potential risks before they balloon into larger issues. Additionally, the system guarantees real-time connectivity with CMS work order systems, which reduces redundancy and improves problem-solving efficiency. Solutions are rolled out in an easily understandable manner, ensuring that all team members are prepared to succeed. The gradual introduction of platform modules allows for smooth integration, helping organizations to adapt to new systems at a comfortable pace. This deliberate strategy not only boosts safety but also cultivates a culture focused on continuous improvement, accountability, and shared responsibility among all team members. Ultimately, this approach ensures that organizations are not just compliant, but also leaders in fostering a safe environment for all.