Provider Network and Data Management Solutions

Efficiently manage network contract information and accurately price claims

Networks are one of the greatest assets a health plan has. Networks serve as the primary point of connection with customers and are one of the primary determinants of cost of services covered. As a result, health plans must focus on the quality of their networks and actively pursue strategies for ongoing improvement.

Manage all aspects of a provider network in a single provider source of truth — from adequacy to recruitment and product, to contract and distribution. Our solution:

  • Performs in-depth review of existing networks and assists in the creation of new networks (geographic, narrow, etc)
  • Efficiently maintains aligned, accurate provider information for directories, fee schedules and other applications
  • Enables new, multi-tiered pricing structures and aligns contracts, fee schedules and data
  • Initiates and tracks credentialing and recruitment processes
  • Accurately models contracts and reimbursement
  • Meets new and future compliance requirements cost effectively and on-time

Optum offers provider data management services that meet key provider network administration challenges, helping to enable:

  • A single view of all aspects of a provider for the organization
  • Real-time analytics against the source of truth
  • Streamlined implementation of new network strategies
  • Lower administrative costs
  • Improved claims payment accuracy and automation
  • Integration with existing processes and systems

Provider Data Solutions

Maintain, improve and expand vital provider data

Provider data touches every facet of a health plan, but with limited resources, most plans struggle to maintain an accurate provider database. Our database tools and sophisticated data management services improve processes that depend on complete and accurate provider data.

Network Analytics Solutions

Collectively these tools can help your plan evaluate its current accessibility and select the right providers for expansion by giving your organization immediate access to their history, credentials and quality feedback.

We’re ready to put our platform to work for you. Let’s start the conversation.
Contact Us 1-866-386-3404

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