Provider Profiles

5 min

Overview

Profiles are the detailed views MedScout provides for individual healthcare providers (HCPs) and sites (hospitals, clinics, and other facilities). A profile brings together everything MedScout knows about a specific entity — procedure history, diagnoses, prescriptions, referral patterns, payer mix, relationships, open payments, education, and rep activity — organized into tabs so users can qualify, research, and plan around that provider or site without piecing it together from separate tools.

Key Capabilities

You can navigate to the Provider or Site of Care profile from any page in MedScout that shows a list of providers or sites by clicking on the provider's/site's name.

Provider Profile presents a comprehensive view of an individual provider, with information organized into tabs that you can use to qualify a provider, do research before a call, and plan outreach. The profile for an individual provider includes

Overview — a snapshot of the provider, including key identifiers and high-level charts (volume, payer mix, and other top-line metrics) so users can get oriented without digging into individual tabs

Activity — logged calls, meetings, notes, and other touchpoints tied to this provider, with a button to log new activity directly from the profile

Procedures — detailed information about procedure (CPT, DRG, ICD, and HCPCS Level II), with ability to search for specific codes as well filter data by category, year, payer, and place of service

Payer Insights — payer mix and average reimbursement data at the provider level (see the Payer InsightsPayer Insights capability below)

Referrals — inbound and outbound referral relationships — who sends patients to this provider, and who they refer patients to. Ability to slice referral data based on code set, add providers to lists, and export data to CSV and Excel

Diagnoses — ICD-10 conditions that this provider treats, with ability to search for specific codes as well filter data by category, year, payer, and place of service

Prescriptions — drug-level data for prescribing providers

Open Payments — payments and transfers of value from medical device and pharmaceutical companies to the provider (Sunshine Act / CMS Open Payments data) with ability to filter by company, year, payment type, product type, and product name

Relationships — affiliations, Group PAC, and hospital system associations that surface the organizational and contractual context around the provider

Site Profile presents a single view of a hospital, clinic, or another facility, organized into tabs that cover the providers practicing there, the procedures and diagnoses billed at the site, referral patterns, payer mix, relationships, and rep activity. You can use it to qualify a site and identify the right providers within it. The profile for a site of care includes

Overview — a snapshot of the site, including key identifiers and high-level charts (volume, payer mix, and other top-line metrics)

Activity — logged touchpoints tied to this site, with a button to log new activity directly from the profile

Procedures — detailed information about procedure (CPT, DRG, ICD, and HCPCS Level II), with ability to search for specific codes as well filter data by category, year, payer, and place of service

Payer Insights — payer mix and average reimbursement data at the site level (see the Payer InsightsPayer Insights capability below)

Providers — providers practicing at this site, including treating and referring providers with associated volume metrics. Ability to filter provider based on code set, add them to lists, and export provider data to CSV and Excel

Referrals — referral relationships at the site level. Ability to filter referrals based on code set, add providers to lists, and export provider data to CSV and Excel

Diagnoses — ICD-10 conditions treated at the site, with ability to search for specific codes as well filter data by category, year, payer, and place of service

Relationships — affiliations, Group PAC, and hospital system associations

You can view payer mix and reimbursement data directly on provider and site profiles, helping you prioritize providers and sites with the most favorable payer relationships for your product.

Navigate to the Overview tab and scroll down to see Payer Mix, including

The distribution of a provider's or site's volume by payer type (commercial, Medicare, Medicaid, etc.) and by specific payer

Average reimbursement by procedure code surfaces the typical dollar amount the provider or site receives for a given CPT, HCPCS, or ICD procedure code

Reimbursement is benchmarked against state averages to highlight providers and sites with above- or below-market rates

Provider-level reimbursement reflects the professional fee (the physician-payer contract); site-level reimbursement reflects the institutional fee (the facility-payer contract)

Capture calls, meetings, notes, and other touchpoints directly from the profile you're researching, so context-switching out of MedScout isn't required mid-workflow. The Activity tab on every profile shows the existing history for that provider or site and provides a button to log new activity. While ActivityActivity is a separate module in MedScout, Profiles is one of the primary places to add new activities.

To log an activity

Click Log Activity in the upper right-hand corner of the screen

Choose activity type from the list.

Optionally, change the Date for the activity (default is the current date)

Optionally, add a Note

Click Log to save

Activities logged from a profile are automatically tied to that record and appear on the profile's Activity tab

There is a bi-directional sync to your CRM for activities (if enabled)

To add provider or site to a list, click + Add To List in the upper right-hand corner of the page

Choose an existing list from the drop-down or click + New List to create a new one

Click Add To List to save

Good to Know

Reimbursement data scope: Payer Insights covers CPT, HCPCS, and ICD procedure codes. DRG and prescription codes are not currently covered. Reimbursement data is focused on the most recent year (with 2022–2024 included in payer mix). Historical reimbursement trending is on the roadmap.

"No Data" on Payer Insights: A provider or site may show "No Data" for reimbursement even when they have volume, because remittance/adjudication data isn't received for every payer.

Payer mix rounding: Within a given code, payer percentages may not sum to exactly 100%. Values under 1% are rounded up to 1%, and values over 1% are rounded to the nearest whole number.

Professional vs. institutional fees: A provider-level reimbursement (professional fee) and a site-level reimbursement (institutional fee) for the same procedure can differ significantly because they are separately negotiated contracts. A hospital may be in-network with a payer while a physician within it is not, or vice versa.

Attribution and NPI types: Profile data can vary based on whether an NPI is the billing NPI or organization NPI on a claim. This affects how volume is attributed and what appears on which profile.

Provider Profiles

Overview

Key Capabilities

Provider (HCP) Profiles

Site (Hospital and Clinic) Profiles

Payer Insights

Log Activities from a Profile

Add Provider to a List

Good to Know