Improving Healthcare Interoperability with Accurate Provider Data
Real-World Solutions for Records Requests and Patient Referrals
Industry Challenge:
The Centers for Medicare and Medicaid Services (CMS) envisions interoperability as “a secure, connected healthcare system that empowers patients and their providers to access and use electronic health information to make better informed and more efficient decisions.” This vision hinges on the availability of accurate healthcare provider and facility data, including critical details like fax numbers and Tax Identification Numbers (TINs). Such data accuracy is essential for facilitating core operational processes, including medical record requests and post-acute care referrals.
Despite advances in digital healthcare solutions, nearly 75% of medical data is still transmitted via fax, amounting to around 9 billion pages per year. However, outdated or incorrect fax numbers and limited ability to source accurate TIN data pose serious operational challenges. The consequences of inaccurate data are significant, including delays in patient care, wasted administrative resources on confirming contact details and re-sending failed faxes, and the risk of violating HIPAA by sending sensitive records to incorrect destinations.
The Impact of Inaccurate Provider Data on Medical Records Requests and Patient Referrals:
Post-Acute Care Referrals: Candor recently onboarded a post-acute care referral client that faced substantial issues due to 20% of their fax numbers being disconnected, making their patient referral operations inefficient and costly. The client team spent hours every week verifying and updating contact information, and without reliable data, they couldn’t fully automate referrals or manage increased patient volumes.
Medical Records Requests: For clients handling medical records requests, the situation was equally complex. To link providers to the correct facilities, staff often had to rely on manual, error-prone search processes. Inaccurate data forced them to re-check details, such as TINs and facility contact information, which led to delays in records processing and limited their capacity to meet client demand.
Often, these processes involve two key steps that can be impacted by inaccurate provider data:
Request Submission: Requesters manually enter provider details, risking errors in data entry.
Request Fulfillment: Client teams needed to search for individual providers and facilities, call to confirm fax numbers, and, ultimately fax the request to the correct department.
Candor’s Solution: Enhancing Data Accuracy to Streamline Workflows:
Post-Acute Care Referrals: Candor partnered with the referral management client to address their fax number issues by deploying an AI-powered solution that verifies and continuously updates fax numbers. Through this approach, Candor was able to identify missing fax data for 48% of the client’s database and resolved 100% of the client’s disconnected numbers. Improved accuracy allowed the client to automate their referral process, achieving a 93% success rate for faxes and enabling a fivefold increase in referral volume.
Medical Records Requests: By integrating with Candor’s Analytics platform, clients streamlined their request submission and fulfillment workflows:
Streamlined Submission: Requesters can search by provider or facility name, with Candor auto-filling verified contact details, thereby reducing the risk of manual errors.
Automated Contact Retrieval: For fulfillment, the operations team now receives up-to-date contact information directly from Candor, eliminating manual searches. Even if a user bypasses a match during submission, the system pulls correct data for final processing.
Increased Capacity: With access to accurate TINs and facility data, one client matched 94% of previously blocked facility records (175,000 of 182,000), enabling them to fulfill requests that would have previously been delayed.
Conclusion:
Candor’s high-confidence provider data solutions support healthcare organizations by reducing errors, expediting processes, and enabling higher processing volumes. Clients report streamlined workflows, reduced operational costs, and faster patient care—key outcomes that support the CMS vision of a connected healthcare system. By improving data accuracy, Candor helps organizations navigate existing infrastructure limitations and supports a more modern, interoperable healthcare ecosystem where patients, providers, and operational teams all benefit.
