MultiPlan’s PHCS Network Receives Eleventh Consecutive NCQA Accreditation in Credentialing

In 2022, MultiPlan’s PHCS Network, the largest primary PPO in the nation, received its 11th consecutive Accreditation in Credentialing from the National Committee for Quality Assurance (NCQA), a private nonprofit organization dedicated to improving health care quality. The PHCS Network is the only national independently contracted primary PPO with NCQA accreditation, demonstrating its unique commitment…

PHCS and NCQA logos with stethoscope

In 2022, MultiPlan’s PHCS Network, the largest primary PPO in the nation, received its 11th consecutive Accreditation in Credentialing from the National Committee for Quality Assurance (NCQA), a private nonprofit organization dedicated to improving health care quality. The PHCS Network is the only national independently contracted primary PPO with NCQA accreditation, demonstrating its unique commitment to the accurate and efficient credentialing of health care professionals.

First certified in 2001, the PHCS Network underwent a rigorous review of its credentialing and recredentialing processes to maintain its NCQA Accreditation in Credentialing. The network received the maximum accreditation period of 3 years. The new accreditation is valid through July 12, 2025.

The NCQA auditor noted the network’s dedicated and knowledgeable staff, fast and easy file review, and “stellar” credentialing and recredentialing files. The auditor also praised the PHCS Network’s facility credentialing program, saying the network’s report was “the best report on initial submission this surveyor has ever seen.”

“It is through our daily commitment to detail, continuous improvement, challenging ourselves and striving to meet the highest quality standard that we are able to maintain our NCQA Accreditation,” said Derek Reis-Larson, MultiPlan’s Senior Vice President of Claims Pricing Services.

About the PHCS Network

The PHCS Network provides health plan members with seamless access to healthcare services across the country, with more than 1,000,000 participating practitioners, 4,800 acute care facilities and 92,000 ancillaries. Clients who use the network see average savings of 42% on practitioner claims, 28% on inpatient claims, 24% on outpatient claims and 46% on ancillary claims.

About NCQA

NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care, with over 60% of the US population enrolled in health plans that use the measure. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa.

About MultiPlan

MultiPlan is committed to helping healthcare payors manage the cost of care, improve their competitiveness and inspire positive change. Leveraging sophisticated technology, data analytics and a team rich with industry experience, MultiPlan interprets customers’ needs and customizes innovative solutions that combine its payment and revenue integrity, network-based and analytics-based services. MultiPlan is a trusted partner to over 700 healthcare payors in the commercial health, government and property and casualty markets. For more information, visit www.multiplan.com.

NCQA has reviewed and accredited Private Healthcare Systems, Inc.’s. (d/b/a PHCS Network) Credentialing functions only. For complete details on the scope of this review, visit www.ncqa.org.

Engaging insights.

New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.

  • Your team is great at building trust. I have had nothing but a positive and efficient experience.

    Manager

    Large Midwest health plan

  • These are really important things that we wouldn’t be able to do without a partner like Claritev because, again, we want to look at this stuff holistically across carriers. It would take me four times as long to go into every health plan and do this kind of analysis.

    Executive Vice President

    Large, regional consulting firm/insurance brokerage

  • They (Claritev) are continuously refining and developing the platform to meet my needs.

    A Major Healthcare Provider

  • The Technology Leadership Program has brought my department tremendous value. The well-structured program offers the talented hardworking associates options for their career paths, yet exposes them to high visibility initiatives. Every associate has brought a unique perspective and strong professional skills to the organization.

    Bobby Vincent

    Senior Information Technology Director

  • The Technology Leadership Program associates have a tremendous opportunity before them. To have three years to rotate through various departments within Information Technology before deciding which role/area suits them best.  Depending on their choice and interest, they become a unique blend of technologist, business expert and, eventually, corporate leader.

    Andrew George

    Senior Vice President, Information Technology

  • One of the great successes of the program has been our ability to identify and develop emerging leaders whom contribute in every facet of our business. It hasn’t been just about growing IT leaders, it’s about maturing business leaders for Claritev.

    Ed Ververs

    Senior Director, Telecom & Data Center Management

  • I had the privilege to mentor some of the Technology Leadership Program participants and was fortunate to absorb a member into my team, where he has helped tremendously with new automation techniques. Participants bring in fresh perspectives and extreme enthusiasm to IT here at Claritev. I’m looking forward to adding more.

    Vasu Raghunathan

    Senior Director of Data & Service Delivery

  • You have been a great partner from day one. You collaborate with us until we find a resolution. We look forward to a long-standing partnership.

    Payment Integrity and Performance Manager

  • The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

    Drew Satriano, VP of Payment Integrity

    Highmark, Inc.

  • In our experience, Claritev has been very responsive with great turnaround times and the findings they’ve presented to SIHO have been accurate and reasonable.

    Claims Department

    SIHO Insurance Services, Inc.

Pattern

Learn how Claritev delivers the objective, market-driven insight you need to make the most complex decisions.