Provides a comprehensive dataset of insurance plans accepted by healthcare providers, sourced from health insurer APIs and machine-readable files. This enables payers, providers, and patients to access accurate, up-to-date information for in-network provider searches, network analysis, and referral management, reducing out-of-network billing and improving healthcare decision-making.
Funding
Funding not disclosed
Founders
Product
Problem
Inaccurate and incomplete data on insurance plans accepted by healthcare providers leads to inefficiencies in network management, patient access, and referral processes. Patients struggle to find in-network providers, resulting in out-of-network billing and increased costs. Payers lack comprehensive data for network analysis and compliance with provider directory regulations.
Solution
Defacto Health offers a comprehensive dataset of insurance plans accepted by healthcare providers, aggregated from health insurer APIs and machine-readable files. This data enables payers to assess the accuracy of their provider directories, identify error clusters, and benchmark their networks against competitors. Health tech companies can leverage the dataset to embed insurance and provider demographics data into their platforms, improving patient access and reducing out-of-network costs. The solution facilitates informed decision-making for patients, providers, and payers by providing up-to-date and reliable information on provider network participation.
Target Audience
The primary customers are payers seeking to improve provider directory accuracy and network analysis, as well as health tech companies looking to integrate insurance and provider data into their platforms.
Features
- Aggregation of insurance plan data from health insurer APIs and machine-readable files
- Coverage of unique health insurance plans with networks in all US states and territories
- Data on practitioners including physicians, dentists, nurses, and other provider types
- Information on provider organizations including hospitals, provider groups, labs, and pharmacies
- Tools for payers to assess provider directory accuracy and benchmark networks
- API for health tech companies to embed insurance and provider data into their solutions