Provider Network Management

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If the processes related to Network Management are conducted manually, they can be labor intensive, error prone and can impede your ability to successfully manage new care coordination and delivery models. Health Plans that make Provider Network Management a priority can operate more efficiently and effectively and are more competitive in the marketplace.

Glenridge technology supports every stage of the Provider Network Lifecycle from the initial build through Network alignment and optimization. Our solutions include:

  • Network Design
  • SMART Recruiting
  • Contracting
  • Provider Data Management
  • Provider Data Accuracy & Validation
  • Compliance
  • Network Optimization & Alignment
  • OON Leakage

Speed to Market – The Glenridge team ensures that all milestones are met for adequacy and that providers are engaged and systems are loaded for marketability. Additionally, our technology enables clients to meet aggressive RFP application and CMS requirements.

Cost Efficiency – Our solutions utilize real-time data and metric reporting, to assure continual resourcing focused on filling gaps needed to meet adequacy requirements.

Network Status Visibility – Glenridge technology can prioritize providers during development which enable competitive negotiations, well-priced networks and ability to monitor actual vs. benchmark targets.

Provider Relations & Branding – Engagement with community providers and facilities establishes cleint’s value proposition and provider relationships to facilitate market penetration.

Payers are challenged to do more with less. Providers are migrating into the Payer world. Glenridge can serve as an extension of your team to:

Payer Approach
Provider Approach
Expand into new markets or develop and build new networks
Optimize current provider networks
Transition into value-based, risk-based contracting or PCMH models
Ensure compliance with state and federal requirements
Perform Medicare filings, HSD Table builds and provider relations support
Develop and implement a payer strategy
Build a provider network or optimize a current provider network