Problem Statement

Care-gap and quality data must stay consistent between the payer and the EMR, and reconciling it manually is repetitive and error-prone. Payers maintain their own record of open care gaps that often doesn't match what the chart in Epic shows, so someone has to compare the two to find the patients whose records need to be updated on the payer portal. Left unreconciled, closed gaps keep showing as open, understating quality performance and the associated incentive revenue.

Automation Solution

This automation compares payer care-gap data against Epic to isolate the patient records that need updating on the payer portal.