Managing a Medicare Advantage network involves complex, resource-intensive tasks—from ensuring adequacy and compliance to credentialing, provider support, and reporting. By offloading these seven network-based functions to a trusted partner, healthcare payors can streamline operations, maintain regulatory alignment, and focus on strategic priorities while improving network performance and efficiency.
Strong provider relationships are the foundation of effective healthcare networks. By leveraging long-standing partnerships, deep provider insights, and an extensive network, healthcare payors can build compliant, high-performing networks faster—improving access to care while maintaining efficiency, flexibility, and strong collaboration across the healthcare ecosystem.
An auto medical services provider wanted to distinguish its network-based cost management program to sensitive auto insurance carriers by demonstrating: minimal provider noise through the use of network contracts to reduce medical cost; effective dispute resolution processing.
A health plan facing tight deadlines needed rapid access to providers to meet network adequacy requirements. By leveraging existing contracted providers and targeted credentialing strategies, Claritev enabled faster network expansion—helping the plan meet compliance requirements, accelerate market entry, and maintain flexibility for future growth.
A workers’ comp services provider needed help maintaining State Certified Managed Care programs by: eliminating provider coverage gaps in geographies not addressed by its proprietary network; strengthening coverage for key medical specialties.
To improve competitiveness, a regional provider-owned health plan needed assistance with: extending network access for its highly mobile membership, containing out-of-network medical cost, and preserving its relationships and reputation with the local provider community.
