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
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.