A healthcare providers’ network is a group of doctors, and other healthcare providers like physiotherapists, home caregivers, clinics, and hospitals included in an insurance payer’s health plan. Each of those entities would have undergone an elaborate process of being onboarded into the plan. This process is called credentialing and it involves a series of verifications, processing, checks, documentation, and paperwork.

A provider network would have individual medical entities operating on a day-to-day basis, and those operations involve medical care, coding, billing, claims, and so forth. The operational efficiency of the network is of concern to the payers since they are the ones who would be footing most of the bills. It is why providers invest significant amounts of resources into healthcare provider management solutions.

It used to be one of the most overlooked aspects at insurance companies. But it has undergone significant changes over the last few years as insurers have realized that the provider and member service ratings would be adversely affected if the right provider data is not furnished at the right time. A report in 2017 discovered that over 40% of the provider directory locations included in online directories were not fully reliable. This information is important as many members rely on these directories to find in-network providers.

Medical network management has become crucial since inefficiencies in proper functioning can increase the chances of online provider directories losing business or even being declared ineligible to bid for new business. Moreover, factors like patient experience, reimbursement of claims, relationship with providers, and credentialing are also bound to suffer. In light of this, solutions for provider network management go a long way in improving the efficiency of the workflows in managing a network of providers. Let’s explore some of the benefits of using a healthcare network management software -

Claims Reimbursement

Inaccurate data about providers is bound to bring down the reliability of data on claims as well as that of providers themselves. Subsequently, it goes on to result in claims being denied or rejected, and appeals for the denied claims. In other words, the problem feeds on itself and leads to a vicious cycle.

But provider management software can help with this by validating the data upfront. Doing so improves the workflow around claims payment and so, reduces the number of appeals from providers. Defending the appeals often costs precious time and resources for payers and anything that prevents that helps all stakeholders concerned.

Faster Onboarding of Providers

Government regulation stipulates strict time periods to complete the credentialing and onboarding of providers as soon as the contract has been signed. However, payers often face lots of struggles meeting these deadlines since the workflows are fragmented. Software for provider data management solutions in healthcare consists of built-in functionalities that streamline all the workflows and boost the productivity of the staff involved in onboarding. Moreover, automation of manual repetitive tasks goes a long way in helping to minimize errors.

Improved Relationships With Providers

It goes without saying that the above-mentioned benefits of using provider network management software are bound to improve ties with providers. There is greater transparency in the credentialing, onboarding, and network management processes.

To sum it up, investing in healthcare provider network solutions benefits the payers, providers, and indirectly, the patients.

Source: https://www.osplabs.com/healthcare-payer-software-solutions/provide...