Payer network and facility network participation
Key Takeaway
Healthcare Payer Network is the network itself. Healthcare Facility Network records which locations and practitioners participate in it, even when no contract details are entered.
A payer network is an insurance network group that a payer offers, such as a PPO plan's network. Network participation records which providers, at which locations, belong to that network, so members can find in-network care. Agentforce Health uses two objects for this: Healthcare Payer Network for the network itself, and Healthcare Facility Network for each participation.
Payer and payer network are separate records
The payer organization is the insurer, and it is a business account. The payer network is a separate Healthcare Payer Network record, which represents the insurance network group. The Healthcare Payer Network record points to the payer organization through its "Payer" field.
Lakeshore Health Plans is the insurer, so it is a business account. Lakeshore Health Plans PPO is its payer network, so it is a Healthcare Payer Network record.
Healthcare Payer Network stores the type of network, such as HMO, PPO, or EPO. The network type is set here, not on Healthcare Facility Network. So if you need to store whether a network is an HMO or a PPO, use the Healthcare Payer Network record.
A Healthcare Payer Network record can also hold details such as an effective date, line of business, and an "Active" flag.