Network Management

Network Management pertains to the process of managing and maintaining a network of service providers, typically healthcare providers, that have agreements with an insurance company. The primary aim is to construct a diverse, high-quality network of providers that policyholders can utilize for insured services.

Network Management

Effective network management is crucial to guarantee that policyholders can access quality healthcare services while also maintaining cost efficiency. Through managing the provider network, insurance companies are able to negotiate advantageous reimbursement rates, advocate for care coordination, and present policyholders with an extensive range of in-network options to fulfill their healthcare needs.

Features of ClaimZippy

Provider Contracting

This function involves the ability to form contractual agreements with healthcare providers. These contracts specify the terms and conditions of participation and entail negotiations on various facets such as reimbursement rates, service coverage, quality standards, and contractual obligations.

Credentialing

Credentialing constitutes the process of validating the qualifications and credentials of providers before incorporating them into the network. This procedure ensures the competency and professionalism of the providers, thereby providing policyholders with confidence regarding the quality of care they can anticipate.

Cost Reduction

Tariff negotiation relates to the capability to negotiate reimbursement rates with healthcare providers for services provided to policyholders. This function may involve the examination of fee schedules, market rates, and provider cost structures to determine mutually agreeable reimbursement rates.