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Category: Network-Solutions

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    These Three Attributes Help Healthcare Payors Manage Costs

    Healthcare payers face constant pressure to control costs in an increasingly complex and fast-moving environment. Success depends on three critical attributes: customization, flexibility, and speed to market. By tailoring solutions to unique organizational needs, remaining agile in response to change, and rapidly deploying effective strategies, payers can better manage costs while maintaining accuracy, efficiency, and member satisfaction. [claritev.com]

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    Building Blocks to Help Healthcare Payors Thrive in Our New Normal

    Healthcare payors are navigating uncertainty in the “new normal,” facing challenges like shifting claim volumes, cost pressures, and limited resources. By leveraging flexible, customizable building blocks—such as network-based, analytics-driven, and payment integrity solutions—organizations can adapt to change, maintain financial control, and strike a balance between cost savings, provider relationships, and member satisfaction. [claritev.com]

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    Seven Network-Based Functions You Should Take Off Your Plate

    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.

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  • Male patient leaning on counter in waiting area as he chats with male doctor and female receptionist on the other side

    Strong Networks Begin with Strong Healthcare Provider Relationships

    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.

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  • Two males and two females at conference table with laptop and coffee

    Case Study: Navigating a challenging environment

    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.

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    Case Study: Meeting a specific need quickly

    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.

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    Case Study: Partnering to achieve certification

    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.

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    Case Study: Leveling the playing field

    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.

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