Provider Network Management

Provider network management solutions support providers and health plans with the processes involved in provider licensing, credentialing and payor enrollment.

On the provider side, these vendors most commonly help provider organizations with getting their clinicians licensed across multiple states. Additionally, they help these organizations enroll their providers with a broad payor base, and in some cases, support them in creating their own delegated credentialing processes. Finally, they provide solutions that help practices to manage their provider data and ensure their clinicians remain in good standing–e.g., tracking license expiries and ensuring CME credits are completed.

On the payor side, these vendors primarily support credentialing activities, improving the speed and accuracy of the primary source verification (PSV) process in particular.