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Providers

Provider Network Management Solutions

Our solutions for the Provider space are centered around the challenges and complexity of Provider Network Management. We have deep industry knowledge in all aspects of recruiting, credentialing, contracting/fee schedules, onboarding and ongoing administration related to keeping everything up to date.

Our solutions are based on the Salesforce Industries Provider Network Management (PNM) offering and can be coupled with source data for Providers from our partner Verifiable. These solutions are delivered with both the internal network team as well as a self-servicing component for the providers in the form of a Provider Portal.

Provider Network Management Pillars

Recruiting
Recruiting
Credentialing
Credentialing
Contracting
Contracting
Onboarding
Onboarding
Self-servicing
Self-servicing
Administering
Administering

Solutions

Recruiting

Aims to identify and recruit the best health service providers into their network. The provider recruiter leads these business processes as part of the health plan recruiting team.

Credentialing

Processes provider applications and verifies their credentials before they join the network. The credentialing specialist leads these business processes as part of the health plan credentialing team.

Contracting

Establishes and agrees on contracts, health plans need draft contracts and provider fee schedules. The contract specialist leads these business processes as part of the health plan contract recruiting team.

Onboarding

Brings service providers into the health plan for optimal success and retention, health plans design and deliver onboarding programs to get providers on board the network. The provider onboarding specialist leads these business processes as part of the health plan onboarding team.

Self-servicing

Support providers by enabling access to claims, payments, and various types of self-servicing, including general support issues. The provider relations specialist leads these business processes as part of the health plan servicing team.

Administering

Provides members with timely access to a sufficient number of in-network providers according to service-level targets. Adequacy involves the analysis of the provider network for adequacy and deficiencies to optimize the network and support continuous improvement.

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