Seven Network-Based Functions You Should Take Off Your Plate

Adequacy, compliancy, credentialing and more — A Medicare Advantage payor must deal with many moving parts when building and maintaining a network. Claritev can handle the details that consume a Medicare Advantage plan’s time and resources. Tap into our tools, resources and talent for network-based functions, such as:

• Determining network adequacy: Our analytics tools, which build upon CMS tools, can create models that look at multiple solutions. Then you can see if your network meets CMS adequacy requirements.

• Recruiting and contracting: Starting with the providers who already contract with us, we pinpoint those with the most volume in a geographic area and the most specialties, helping your plan meet adequacy and availability requirements under one contract. 

• Staying compliant: We know how to structure flexibility into a contract. We can amend a contract when CMS makes specific language changes, ensuring your plan’s network stays compliant.

• Credentialing and recredentialing: Our team reviews provider applications and maintains network participation criteria. Our credentialing guidelines, policies and processes are prepared in consideration of the NCQA and Medicare Advantage regulatory standards and guidelines. We have also achieved operational efficiency around the complex area of recredentialing.

• Maintaining provider data: We keep demographic information accurate through outreach, data scrubbing, group roster procurement, and web-based solutions.

• Supporting providers: Among our outreach services, we handle on-boarding and provide network participation information. We also communicate General Compliance and Fraud, Waste and Abuse (FWA) training to providers in our networks.
• Reporting: We keep your plan in the know with various reports that detail completion of the contracts, achievement of milestones, network adequacy to support CMS filing, geo access studies, and disruption analysis.

Let Claritev do the heavy lifting, so you can make the most of your network access strategy.  To learn more about our Network-Based Services for Medicare Advantage Plans, read this white paper.