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Wherever you are in the
Provider Network Lifecycle…
We’ve got you covered!

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We Build Networks that are Complete, Compliant and Right on Time.

Network Development

  • Market Assessment
  • Recruit Providers
  • Contract Providers

Network Development

  • Market Assessment
  • Recruit Providers
  • Contract Providers

Maintain Compliance

  • Adequacy Review
  • State Regulations
  • Federal Regulations

 

Maintain Compliance

  • Adequacy Review
  • State Regulations
  • Federal Regulations

 

Network Optimization

  • Alignment
  • Manage Leakage
  • Value-Based Payments

 

Network Optimization

  • Alignment
  • Manage Leakage
  • Value-Based Payments

Network Development

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Market Assessment

Regardless of what kind of network you are building, our team starts with a full analysis of the target markets, beginning with a review of the provider universe. We use current market knowledge and data compiled from multiple sources to review the provider landscape (per market). Then we identify provider targets and prepare a Market Scorecard. You’ll know where you should – and more importantly, shouldn’t — expand.

Smart Recruiting

Our proprietary Smart Recruiting technology coupled with available CMS data analyzes adequacy, cost and quality measures to identify priority provider targets. Utilizing these measures ensures that each network is aligned and high-performing. During the recruiting process, we continually re-prioritize your targets, which gives you the straightest path to adequacy and speeds your go-to-market.

Provider Network Contracting & Management

Acting on your behalf or as an extension of your team, we utilize our proprietary WebTrack platform to establish a customized, real-time, dynamic database that serves as both your contracting management and reporting system, and your provider directory database.

WE IDENTIFY YOUR COMPETITION AND TELL YOU WHICH RATES WILL ATTRACT THE MOST DESIRABLE PROVIDERS.

Network Development

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Contracting & Reporting

Depending on your needs, we can conduct any (or all) of the following contracting activities:

  • Physical mailing of contracts
  • Recruiter outreach/prioritization
  • Contract redlines management
  • Contract status dashboards
  • Network Adequacy status

Provider Directory & Data Management

When a contract is accepted, our team validates demographic information based on the requirements established by our clients. Our methods of data collection and the seamless transfer of data to our clients’ systems, reduce errors and ensure that the provider directory is complete, compliant and ready for filing.

Credentialing

Historically, provider credentialing has been a manual process that is tedious and error-prone. Health plans risk incurring additional costs, missing key filing deadlines and dissatisfying their providers.
 
We’ve partnered with an industry leader to seamlessly integrate credentialing services with our robust Network Development services. Our credentialing partner offers tech-enabled solutions that automate the primary source verification process required to create a fully compliant and credentialed network.

Maintain Compliance

Keeping you in check

As CMS continues to closely monitor Medicare Advantage plans, Health Plans must maintain Adequacy and Directory Accuracy on all existing provider networks, or risk fines and penalties that can hinder their ability to succeed in the marketplace. We test your current networks to identify gaps, and then we:

  • Identify the right providers to fill those gaps
  • Conduct recruiting and contracting
  • Prepare new HSD tables to Medicare specifications

Benefits of Compliance

  • Ensure federal and state compliance
  • Improve member satisfaction
  • Protect/enhance Star Ratings
  • Enhance provider engagement
  • Improve your health plan’s brand position

CMS Provider Directory Review

 

Network Optimization

WE ENSURE THAT YOUR NETWORKS REMAIN MARKETABLE, COMPETITIVE, ALIGNED, AND COST-EFFECTIVE.

Minimize Network Leakage & Strengthen Referral Networks

Once a provider network is launched, it’s imperative that you analyze its performance. We examine beneficiary enrollment, eligibility and claims data, and benchmark KPI’s to improve your plan’s case mix.

Using your claims data, we can map patterns of care in local markets identifying how and by whom care is currently delivered. This enables us to identify and pursue high-value providers in each market based on patient volumes, or within each contracted hospital’s service delivery area. Your networks remain marketable, competitive, aligned, and cost-effective.

And, if we find that the only way to maximize your networks’ cost-efficiency is to begin the transition to value-based contracts, our experts can guide you through the process.