Digital Themes

Provider Network Management

What is provider network management?

Provider network management solutions collect data from across health care ecosystems in order to increase operational efficiencies. These data management systems can provide a single point of access for information regarding fee schedules, health plans, regulatory compliance, and processes, as well as other data across a healthcare organization. Provider network management software automates many of the processes that healthcare payers must deal with on a daily basis, thereby saving time and expense in comparison with traditional manual procedures.

Provider network management systems can be used to consolidate patients’ data including care plans, lab results, authorizations, and medical claims. By consolidating this information, businesses can save time and effort in comparison with searching through multiple systems. These systems can also have automated processes that will send secure alerts to patients as necessary, such as appointment reminders or confirmation of claim statuses. Provider network management systems can also be provisioned to allow secure access from the patient side as well, so that patients can stay up to date with their healthcare plan.

Such systems also include methods for data storage and analysis. Data can be gathered from a wide variety of sources, including how new patients are finding their way to the practice. For example, data can be gathered regarding who clicks what marketing links in order to figure out which marketing strategies are most effective. Analysis can also be performed as part of claim submissions, including identifications regarding which physicians are utilizing what services and solutions, as well as which referrals are being made to which providers. Further insights can be gained regarding potential areas of expansion, both for product offerings and new patients. By analyzing the market, as well as current offerings, healthcare providers can identify areas of opportunity for expansion.

Healthcare providers can gain further understanding of their reimbursement procedures as well. Provider network management systems can analyze the entire claim process. By looking at their current pricing and rates, organizations can identify where pricing could be more competitive, or how best to optimize their interactions with insurance agencies to ensure proper rate negotiations are occurring. Furthermore, providers can gain clear insights into their current workload in order to identify areas of inefficiencies and improve procedures.


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Provider network management software can benefit healthcare organizations by:

  • Automating processes: Rather than having to invest many man hours in repetitive tasks, provider network management software can automatically perform many processes, such as provider contracting and data analysis. This additionally helps lower payroll costs, as well as helping to reduce costs as part of contracting.

  • Providing a “single source of truth”: Healthcare providers benefit from having a single source to go to for all data and analytics. Rather than having to search through multiple systems, healthcare payers can quickly find what they are looking for.

  • Increased business intelligence: Through the use of automated data gathering and analytics, healthcare organizations can have a better understanding of their business structure, such as what processes could be improved, or which marketing strategy is yielding the best results.
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