One of the most demanding tasks for any payer is establishing a new provider network or expanding an existing one. Many factors must be considered, such as the payer’s revenue and growth trajectory, potential for the network to lower medical costs, and viability of the network to meet the member’s needs. These are just a few which are key to successful network builds, and we will explore how important they are to network administration. Because the contracting and credentialing involved is often time- and labor-intensive, payers rely on healthcare agencies like ARC to handle the paperwork and negotiations on their behalf. So what does a provider network strategy look like to us? Here’s a breakdown of the steps we take to ensure a successful partnership.
This step in the build comprises our entire engagement with these providers, from laying out your intended program with them, negotiating their reimbursements, and confirming a timeline for them to enter your network. One of the biggest pitfalls comes down to the paperwork. Whether it’s updating provider language and plan rates for contracts, or collecting the appropriate credentials regarding licenses, board certifications, and malpractice history. We assist to gather all elements needed to load your providers as participating, reducing turnaround times, and decreasing multiple & duplicative outreach attempts.
Once contracts have been signed and providers have confirmed start dates to enter your network, it’s time for us to pass on all related documentation to your team. This includes a quality checklist to confirm appropriate steps in the credentialing process are complete, and that providers meet your plan standards. Our handoff to you will be seamless so that you can circle back with them immediately and welcome them to your network.
Are you in the beginning stages of a new network build? Let’s talk about it! Drop us a line at +1 888-552-0677, or click here to submit a request through our website.
ARC Healthcare specializes in delivering scalable solutions for the healthcare and insurance industries. We are your trusted partner for Provider Network Development, Consulting, and Healthcare Support Services.