HealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsDeliver custom or industry designed product training directly to patient and resident care environments to reinforce proper use.
View All ProductsStop wasting money on RCM issues. Learn how to Provide your team with expert-led revenue cycle training to help them reduce denied claims, reimbursement mistakes, and more.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsTackle all the challenges of provider directory management within a health plan with a single solution tailored to your specific needs.
View All ProductsOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsFinally, a comprehensive resource to support collecting, storing, and sharing credentialing data with ease.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreIn the ever-evolving healthcare landscape, health plans are tasked with delivering quality care and navigating a complex regulatory environment in which effective Provider Data Management (PDM) plays a key role. Several critical laws, including the Affordable Care Act (ACA), The No Surprises Act (NSA), and the Consolidated Appropriations Act (CAA), both govern and necessitate how and why PDM has risen in such rapid prominence over the last several years. In addition, accrediting bodies such as the National Committee on Healthcare Quality (NCQA) and Utilization Review Accreditation Commission (URAC) play another critical role in setting policies and procedures for this crucial function. The following article will demonstrate how Network by HealthStream® supports adherence to these laws and standards, thereby contributing to a more reliable and transparent healthcare system.
Overview: Enacted in 2010, the ACA includes provisions that impact PDM practices, particularly concerning network adequacy and quality of care.
Network by HealthStream Impact:
Overview: Effective from January 1, 2022, this act aims to protect patients from unexpected medical bills, mainly from out-of-network providers.
Network by HealthStream Impact:
Overview: This act, revised by Congress in 1986, addresses fraud and abuse in federal healthcare programs.
Network by HealthStream Impact:
Overview: This act, adopted in 2021, is a comprehensive piece of legislation that addresses areas like surprise billing, transparency, and insurance.
Network by HealthStream Impact:
Formed in 1990 as an independent non-profit, NCQA has been at the forefront of healthcare quality standards for years. Prompted by the rise in managed care utilization, which introduced patients to new types of care providers, the need for standardized quality measures across the healthcare spectrum was born. Now, in the present day, the quality standards that they’ve rolled out, such as The Healthcare Effectiveness Data and Information Set (HEDIS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), are household names. Because the verification and validation of provider data are often considered to be the front lines for patient safety, NCQA has long been the standard accrediting and certifying body on a healthcare organization’s (providers and payors) credentialing practices, looking at everything from provider rights, committee review, cycle lengths, delegation agreements, audit procedures, and data governance/backup.
In 1990, URAC was also formed as an independent non-profit, providing accreditation, certification, and measurement programs for a wide range of healthcare organizations. It was initially established to improve utilization review processes, which assess the necessity and efficiency of healthcare services provided to patients. While URAC is used less frequently than NCQA for accrediting health plan credentialing practices, it is still an important accreditation body. It is preferred in certain situations, particularly when a health plan emphasizes operational flexibility and specialized services. URAC’s standards may be more attractive for plans focusing on or offering more niche services to their members, such as:
Regardless of if you’re using NCQA or URAC as your accrediting body, Network by HealthStream offers the industry's only network relationship management (NRM) system. Seed your database with your provider’s data from national sources, leverage our industry-leading Primary Source Verification (PSV) tools, and continuously stream updated provider data to all corners of your operation.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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