Get answers to frequently asked questions about Enclarity.
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Click on a question below to be taken directly to the answer:What business problem does Enclarity solve? Which applications are Enclarity's solutions most valuable for? How do we determine the value of Enclarity's solution for our business? Who are the investors in Enclarity? What are Enclarity's plans as a company? Who is Enclarity's competition? How is Enclarity different from its competitors? What is the total number of providers in the United States? What percentage of all providers nationwide does Enclarity have in its database? How often does provider data change? Industry-wide, what percentage of provider data is flawed? How does Enclarity measure information quality? How accurate can Enclarity make our information? How much should we expect information quality to improve in the first few months of using Enclarity? Is Enclarity's solution a software or a service? What information is included in Enclarity's solution? Where does Enclarity get its data? How many data sources does Enclarity have and who are they? How does Enclarity verify the accuracy of the data? How does Enclarity decide which data elements are right? Does Enclarity's solution include the NPI number? How does Enclarity handle NPI for groups? What are Enclarity's development plans? How do we know which Enclarity solution or solutions we need? How do Enclarity's solutions work? How long does it take to implement Enclarity's solution? How do we work with Enclarity after we become a client? How many resources are required to work with Enclarity? How do we use the information Enclarity returns to us? Can you interface with our various systems such as claims, directories, etc.? How much can we expect to pay for Enclarity's solutions? Are there any fees other than the subscription fee? How often should Enclarity clean our file?
What business problem does Enclarity solve?Approximately 2 ½ percent of provider demographic information changes each month. Other aspects of provider information, such as licenses, sanctions and status also change frequently, making it next to impossible for organizations to establish and maintain the level of provider information quality they need to operate successfully. As a result, Enclarity finds errors in about 40% of the provider records it receives from payers, and about 20% of claims fail to auto-adjudicate, with 25-50% of those failures due to bad demographic data.It is estimated that bad provider data costs the United States $26 billion annually. Enclarity solves healthcare's provider information problem. The company delivers correct, current and comprehensive provider information solutions by blending thousands of data sources, advanced analytics and healthcare expertise. As a result, our clients improve results in many areas, including claims processing, provider directories and network analysis. Because healthcare provider information is continually changing, the challenge is not just getting it right at a point in time, it's keeping it right. This problem is analogous to every consumer's need to keep their virus protection software up-to-date. That's why Enclarity's solutions are available on a hosted, subscription basis, with update schedules determined by its clients. Back to top
Which applications are Enclarity's solutions most valuable for?Enclarity's information solutions are valuable in any situation where reliable, accurate information about healthcare providers is needed - and where the lack of it causes organizations to incur additional costs to overcome the resulting inefficiencies. Enclarity's Master Provider Referential Database (MPRD) includes demographic information, key indicators including NPI number, and medical credentials. Enclarity's clients report:
How do we determine the value of Enclarity's solution for our business?Most Enclarity clients establish a baseline for information quality during their buying process. They supply Enclarity with a subset of their provider file, and Enclarity performs a Proof of Value engagement, which establishes a baseline EQI™ score and enables Enclarity to accurately estimate how information quality should improve over time and the value they will receive. This engagement gives clients a new understanding of the state-of-the-state of their provider files, provides a baseline for monitoring changes, and enables the development of a sound business case, including expected return on investment. Back to top
Who are the investors in Enclarity?Enclarity's investors include Bain Capital Ventures and Ignition Partners. Back to top
What are Enclarity's plans as a company?Enclarity is, and expects to remain, focused on solving healthcare's provider information problem. Back to top
Who is Enclarity's competition?Enclarity's clients include many of the largest payers. Enclarity does not know of a competitor with a solution of similar high quality or similar extensive payer expertise.Prior to choosing Enclarity, those organizations typically attempted to solve their provider information themselves. Their attempts typically include the use of one or more of the following, each of which may claim to solve the provider information problem on its own: data lists, middleware (software that moves data between databases and systems that may or may not match data records), business process management software, business rules engines, functionality included in operational software, and internally developed software applications. Despite those efforts, Enclarity finds errors in about 40% of the provider records it receives from payers, and about 20% of claims fail to auto-adjudicate, with 25-50% of those failures due to bad demographic data. The reasons that attempts fail vary, but most are associated with the sources of data used, the ability to identify the best information for each data element from those sources, the ability to match records accurately, and how often the information is updated. Back to top
How is Enclarity different from its competitors?Since its inception, Enclarity has focused on solving healthcare's provider information problem. Its outstanding staff has worked within a culture of continual improvement and innovation to produce the Enclarity Advantage:
To read more about the Enclarity advantage, click here.
What is the total number of providers in the United States?Healthcare organizations should be wary of the counts of providers supplied by vendors. Higher is not always better - the key is to get the right number, and to have the providers who comprise that number be the right ones within the area the organization serves. As of the end of 2007, there were approximately 950,000 licensed MDs and DOs in the United States, of which about 750,000 were actively practicing. As of the end of 2006, there were approximately 80,000 chiropractors according to the American Chiropractic Association and 200,000 dentists according to the American Dental Association. It is currently estimated that there are between 1.8 and 2 million ancillary providers and about 500,000 facilities. Back to top
What percentage of all providers nationwide does Enclarity have in its database?Delivering high quality information goes beyond simply having a high total number of providers, or even having the right number of providers of a particular type.The first critical question is whether or not information on the right providers is available - or is the total count inflated by duplicate records, providers that aren't active, etc. The next step in assessing the value of provider information also requires a review of the quantity and quality of information for the various data elements associated with each provider. Enclarity taps a wide array of data sources, including every source of licensure and registration data, with the goal of compiling correct, current and comprehensive information for every entity that could submit a claim. Today, Enclarity offers extensive information on over 97% of the key types of providers, such as MDs and DOs, and updates its Master Provider Referential Database continually to provide its clients with correct, current, comprehensive information across all the data elements associated with each provider. Back to top
How often does provider data change?Provider data changes all the time. Physicians move offices, join new groups, go inactive, etc. continually. Approximately 2 ½ percent of provider demographic information changes each month. Other aspects of provider information, such as licenses, sanctions and status also change frequently.Because healthcare provider information is continually changing, the challenge is not just getting it right at a point in time, it's keeping it right. This problem is analogous to every consumer's need to keep their virus protection software up-to-date. That's why Enclarity's solutions are available on a hosted, subscription basis, with update schedules determined by its clients. Back to top
Industry-wide, what percentage of provider data is flawed?Enclarity typically finds errors of some sort - data that needs to be standardized or corrected, or is missing - in about 40% of the provider records it receives from prospective clients. The error rate varies across the range of data elements, with error rates for the core demographic elements typically in excess of 20%. Back to top
How does Enclarity measure information quality?The EQI is a standardized score that enables an organization to measure its information quality at a point-in-time, compare quality over time, and to compare quality across sources and even with other organizations. The EQI is a sophisticated statistical formula that compares the quality of information in a file across all of its elements to the directly verified information from authority sources and phone calls. EQI scores can range from 0 to 950; the first provider file Enclarity receives from an organization typically receives an EQI score of approximately 600. Back to top
How accurate can Enclarity make our information?Enclarity clients who are fully up and running can expect to have EQI scores of over 900, which represents approximately 93 to 95% accuracy across the full range of information. The score achieved varies based a number of factors, including the frequency of updates and each organization's business decisions about whether to accept changes automatically or to investigate certain types of changes further before making them. Back to top
How much should we expect information quality to improve in the first few months of using Enclarity?The answer to this question varies based on a number of factors, including the quality of information before Enclarity, the frequency of updates and each organization's decisions about whether to automatically accept changes from Enclarity or to investigate them further before making them. Organizations with typical pre-Enclarity information quality that employ typical business rules usually experience immediate improvement of 25 to 40% in the number of provider records that have correct, current information for all elements . Back to top
Is Enclarity's solution a software or a service?ProviderPoint®, Enclarity's flagship solution, is a hosted service, as are Provider SelectFile® and NPI Match®. ProviderLookup® is a software-as-a-service offering. Back to top
What information is included in Enclarity's solution?Enclarity provides three categories of information about each provider: demographic, key identifiers including NPI number and medical credentials. For each data element in those categories, Enclarity provides, on average, an additional five fields dedicated to recording data about each element's quality. Back to top
Where does Enclarity get its data? How many data sources does Enclarity have and who are they?Enclarity taps public and private data sources for referential and transactional data. The specifics of which sources Enclarity uses is a proprietary trade secret.For some data elements, such as licenses, Enclarity uses authority sources, such as state boards. Another example of an authority source used by Enclarity is the NPPES file for NPI numbers. Those sources provide definitive answers for the data elements they are purpose-built for, but they may not be the best source for data elements. So, Enclarity uses other methods to find and determine the best source for other data elements, including calling physicians to verify demographic information, and provides clients with information that enables each client to make a business decision about whether or not to further verify an element before making a change or addition to its provider file. Back to top
How does Enclarity verify the accuracy of the data? How does Enclarity decide which data elements are right?Enclarity uses a combination of authority sources, direct verification, and a sophisticated analytical approach that considers 30 factors, including statistical techniques such as cluster analysis, to test and validate the accuracy of each data element and its match to a particular provider, and to establish the associated confidence scores it provides to its clients. In addition to systematically collecting and analyzing data, Enclarity "self audits" the information it is ready to deliver to assess the quality of information as a provider to its clients, and works with certain clients in a closed-loop, consortium approach that provides an additional quality check. Back to top
Does Enclarity's solution include the NPI number? How does Enclarity handle NPI for groups?Yes. Enclarity overcomes the complexities and inaccuracies of the NPPES file to accurately match Type 1 information to individuals, to list the NPI numbers associated with a Type 2 entity by connecting sub-parts to parents, and to deliver taxonomy information. Back to top
What are Enclarity's development plans?Enclarity invests in significant ongoing R&D. We are committed to short delivery cycles so that we can continue the market leadership that caused Frost & Sullivan to name us the Global Healthcare Product of the Year.We do ongoing development work of four major types:
Contact your Enclarity representative to learn about what is coming next from Enclarity's innovative R&D staff. Back to top
How do we know which Enclarity solution or solutions we need?The answer depends on your business needs, especially the application you are doing, and what type of work you would like to outsource.ProviderPoint is selected by organizations that want to fully outsource the cleaning and augmentation of their provider master file, claims files or other files that contain data about healthcare providers. ProviderLookup is chosen by organizations that want to enable people to use a web browser to quickly find information about an individual provider. Provider SelectFile is for organizations who want provider information, but either don't plan to integrate that information into other files, databases or systems, or who prefer to handle that integration themselves. NPI Match appends NPI information to an organization's provider master file or other provider files. Back to top
How do Enclarity's solutions work?Each Enclarity information solution leverages Enclarity's Master Provider Referential Database in a different way.ProviderPoint, Enclarity's flagship solution, is a virtuous circle that includes the following steps:
ProviderLookup, Enclarity's web-based solution that enables people to look up information about specific providers, works more simply - it only requires a web browser and a valid password. Provider SelectFile, an Enclarity solution that delivers information defined by provider type, geographic area and data elements. The client specifies the information set needed. Enclarity then taps the MPRD to find that information, creates a file containing it, and delivers it to the client. NPI Match follows a process similar to ProviderPoint's, starting with the client sending a file to Enclarity and ending with a file being delivered to the client. Unlike ProviderPoint, NPI Match does not clean, update and augment the entire provider record. Instead, its deliverables are focused on NPI information, including Type 1, Type 2 and taxonomies. Back to top
How long does it take to implement Enclarity's solution?The answer has three key variables: the Enclarity solution, the application the information will be used in and project-specific timing, especially timing affected by resource availability. Rules of thumb by solution are:
How do we work with Enclarity after we become a client?Enclarity commits to being a partner with its clients, not just a supplier. The key steps in a ProviderPoint implementation are:
How many resources are required to work with Enclarity?The answer depends on the planned use of information and, often, on the client's internal requirements and preferences, especially in terms of the business decision about the trade-off between accepting Enclarity information automatically and the cost and time of verifying certain types of changes manually before implementing them.Based on experience, Enclarity recommends that three types of resources be assigned, each typically on a part-time basis, for the best results: a business owner, a business expert/project lead, and a technical expert/project lead. Back to top
How do we use the information Enclarity returns to us?Enclarity provides supplemental information about updated and augmented data elements that it easy for clients' to take action. Each Enclarity client establishes business rules and associated processes based on its own judgment about the cost/benefit trade-off between accepting Enclarity's information automatically and investing in additional verification of the data before making changes.Enclarity works with each client to classify each potential change into categories based on Enclarity's confidence in the change and to make a business decision about what action to take with the information in each category. Back to top
Can you interface with our various systems such as claims, directories, etc.?Enclarity takes a simple, straightforward approach to file delivery that minimizes its clients' integration effort. Enclarity works with each client to define input and output fields appropriately, and delivers a flat file that is easily loaded into operational systems. Back to top
How much can we expect to pay for Enclarity's solutions?The key variables that determine the price of ProviderPoint, Provider SelectFile and NPI Match are the number of providers, the frequency of updates and the permitted use of the information. ProviderLookup pricing is established based on the number of users. Back to top
Are there any fees other than the subscription fee?ProviderPoint implementations require a consulting fee for services delivered during the start-up period. There are no required additional fees for the other solutions. Additional services, such as phone verification services, are available. Back to top
How often should Enclarity clean our file?The answer - daily, weekly, monthly or even quarterly - depends on the use of the information, your budget and your decisions about what additional actions are taken to verify information Enclarity delivers to you. Provider demographic information changes rapidly - about 2½ percent per month. For high volume applications such as claims where inaccurate information can be very costly, daily or weekly cycles are best. For other types of applications, we recommend at least monthly updates. Back to top
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