Provider Network Optimization Solutions
Solutions for health plans to help them easily identify medical costs saving opportunities and automate the end-to-end contract lifecycle
Health plans are under immense pressure to identify savings opportunities in provider contracts, and to bring them to fruition.
It’s a difficult challenge, especially for plans lacking analytic resources and easy-to-use tools, or the reimbursement expertise needed to evaluate large, complex claims-data sets.
Even after savings are identified and established, they may fail to materialize due to reliance on manual processes, which are costly as well as prone to misinterpretation of contract terms and configuration errors.
By simplifying and automating the provider contracting lifecycle, we help make it easier for health plans to identify and implement savings opportunities to obtain maximum value from provider relationships.
Our suite of contract analysis capabilities helps health plans measure and monitor contract performance.
Once strategies are defined, we help automate the contracting process so that intent is accurately reflected in contracts and payment systems, and we also provide tools to efficiently capture and maintain ever-changing provider data.
Analyzing large claims data sets for numerous provider contracts is challenging and can limit health plans’ ability to routinely measure contract performance.
By creating a constantly-refreshed claims data repository and building contract models, we make it easy for provider relations teams to monitor performance and evaluate alternative payment options.
Manual provider contracting increases both administrative costs and the risk of unapproved terms being integrated into contracts.
By automating many of the steps in the contracting life-cycle, we help streamline the process, reduce risk, and improve payment accuracy.
Provider information is constantly changing, with new providers entering practices and new office locations being added.
Keeping this information up-to-date, as well as contract and network relationships, is critical to ensuring payment accuracy.
We help automate the maintenance of provider information across the health plan to help ensure correct, current provider information is used when making claims payment decisions.