Network Development Success

Health plan networks represent an organization of physicians, hospitals, medical personnel, and facilities brought together to deliver care to a specific set of customers. 

Building one can be a challenge. Many plans face the difficult task of capturing accurate information describing provider contracts and health plan member services. That includes tracking the enrollment, participation, credentialing, and claims’ payments for providers and their customers.

While larger health plans have invested in fully automating this enrollment, credentialing, and published provider data, smaller plans often lack the resources and capital necessary. 

Building a health plan network is not for the “faint of heart.”

Their subsequent reliance on more manual processes often limits or negatively affects the support they can offer to ACOs, DCEs, MCOs, and ISNPs, including specialized health plans that are state or regionally based. 

Considering all of the regulations, certifications, and paperwork that goes into the creation of a successful network, it’s not surprising that many of these smaller health plans turn to payer-provider contracting firms for help. That includes ARC Healthcare, which has the resources and expertise to respond to Medicare, Medicaid, and commercial requests for proposal—whether it’s meeting individual state requirements or addressing federal focus areas. We also advise networks on how to grow and innovate by developing a diverse panel of 40+ specialties.

Our network development process includes a rapid push to draft contracts with approved language, targeted strategies, rate negotiations, and more. This leads to total provider buy-in with a full contract or a Letter of Intent (LOI), depending on what the state allows.

Sourcing providers requires experienced personnel who “geek out” on the data and analytics for building a successful network.

Once the list of providers, hospitals, and other medical personnel are identified, our contracting and credentialing strategies involve:

  • All licenses and certifications
  • Certificates of Insurance (COIs), with payers listed as the certificate holders
  • Attestation Forms, completed by all providers
  • W-9 Forms, completed by all providers
  • Data Collection forms and CAQH information
  • Residential summaries
  • Direct Deposit forms, including cancelled or voided checks

If you’re considering a partnership with an outside firm like ours to help manage your network development, it’s a good idea to weigh your options. Interview at least 5 – 10 others and compare their proposals before making a final decision. We also recommend that you ask those firms how they’ve designed their processes, and what technologies they use.

Connect with us today to learn more about how we manage ours, and take a look at our contracting automation solution, Fourleaf.