Conduent Broadens Healthcare Payer Portfolio with New Innovative AI-Driven Provider Data Management Solution for Health Plans

Conduent Incorporated  a global technology-led business solutions and services company, announced a new Provider Data Management (PDM) solution that brings health insurance companies a single, real-time data source to ensure the accuracy of their doctors’ directories. The PDM uses innovative AI and advanced analytics to collect, validate and communicate a doctor’s participation within a network, demographic revisions and other key data points. The company’s newest solution enables health insurance companies to improve claims auto-adjudication rates by reducing common data errors—such as incorrect addresses and speciality information—and enhances doctor and member satisfaction with accurate, up-to-date information to avoid surprise bills and connect the patient to the right in-network provider.

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The No Surprises Act mandates that health plans update their directories within 48 hours of changes to doctor information to avoid steep penalties. As health insurance companies continue to use manual, resource-heavy processes, they run the risk of noncompliance with the law. Conduent’s PDM solution leverages AI and automation to drive critical daily information updates, while dedicated call center professionals reach out to providers to verify missing or incomplete information.

“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 at Conduent.

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The PDM is the newest addition to Conduent’s suite of end-to-end Healthcare Payer solutions to manage health plan administration. From member enrollment to claims management, the company’s software and services have helped health insurance companies engage members, meet compliance requirements, optimize cost of care and improve overall operational performance for more than 40 years. Conduent.

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