Although Financial Systems across the world have implemented strict data reconciliation from the very first day, health care industries are slow to implement proper data reconciliation methodologies. Proper reconciliation ensures data integrity within a system and across systems. Not having an effective reconciliation methodology is ultimately impacting the consumers and costing stakeholders significant money. Although all aspects of health care industries can benefit implementing reconciliation, this white paper only discusses how reconciliation can help in the health eligibility areas.
Reconciliation assures that information is absorbed when communicated either within or acrosssystems. Reconciliation ensures that the system is properly processing the information after it has receives the information from another system (internal/external). Reconciliation ensures that integrity of the information is properly maintained and does not go out of sync.
In Healthcare, before a consumer can have health insurance, the consumer is evaluated for eligibility and if eligible, the consumer is allowed to select a plan and have health insurance. The system that determines the eligibility is different than the system that provides the insurance coverage. Quiet often these systems get out of sync. When these systems gets out of sync there are emotional and financial consequence. A proper reconciliation methodology can identify the discrepancies and help resolving it.
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Modernizing healthcare necessitates the computerization and seamless integration of all the different, interlocking systems involved in the delivery of care - from determining Medicare eligibilities, to the storing and updating health records, to the processing of insurance claims. A vast amount of information is stored and communicated across these systems. Maintaining a high standard of data quality is thus a cornerstone of the successful operation of any part of the healthcare system, no matter how small or large.
A key attribute of data quality is that each and every record within a system should represent a distinct entity. Duplicate records are yet ubiquitous and represent a preventable burden upon the quality and costs of the healthcare system.
This white paper discusses the nature of duplicate records in healthcare - its causes and effects; this paper then proceeds to outline possible solutions and the challenges those solutions must overcome. This paper concludes by detailing our own solution and summarizes the results of its initial deployment.
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