Case Study: Meeting a specific need quickly

The Challenge

Government – Network-Based

A full-risk plan looking to expand into adjacent counties needed:

• Assistance with provider network access to meet a looming filing deadline
• Selective access to providers post-filing, as needed to meet network adequacy requirements

The Solution

Claritev analysis identified providers under contract that could:

• Add immediate value for the filing process by filling gaps in the plan’s network
• Be accessed on an ongoing basis or until the plan could complete contracting efforts

The Results

Claritev contributed nearly 700 Medicare providers to the filing and credentialed 20% of the providers to enable ongoing access, helping the plan to:

• Meet its adequacy requirements for plan-to-plan contracts
• Successfully apply for a CMS contract in two of the counties