EPISODE DESCRIPTION

A health plan's claims kept getting denied. Everyone blamed the new claims system. Melissa Goshorn's team found the real cause somewhere else: the provider data feeding that system and the transformations it went through on the way in. Denials dropped 97%. Nobody had suspected provider data at all. Melissa is president of DocMe Health, the health division of DocMe360, where the model is to work inside a health plan's systems and files instead of handing over an assessment and leaving. She spent close to a decade supporting CAQH and its provider data solutions. In this conversation with Nick and Mitch, she argues that provider data is the most overlooked data in healthcare, and the data every other system depends on.

Key takeaways