Provider network management for onboarding, credentialing and contracting
Key Takeaway
A provider moves through recruitment, credentialing and contracting, then into a network participation. To enroll a provider group's practitioners in one batch, place the Network Participation Lightning component on the group's Business Account record page.
Provider Network Management is an add-on for Agentforce Health that payers and provider groups use to bring providers into a network. Recruiting, credentialing and contracting providers used to be slow and manual. The add-on replaces that work with guided, Omnistudio-based workflows, a self-service Provider Portal, and a data model for applications, credentials, contracts and network participation.
How a provider joins a payer network
A provider joins a payer network through handoffs between payer teams, in this order:
- The network management team analyzes the provider directory to find current and potential providers.
- The recruiting team runs marketing campaigns or events to attract providers. The team then works the leads that come in and sends the provider an application.
- The provider completes the online application in the Provider Portal.
- The credentialing team reviews the application for compliance and approves it.
- The credentialing team discusses terms such as prior authorizations, reimbursements, claims processing, rates and disputes. The team then creates and sends the contract.
- The provider signs the contract, sometimes after negotiation.
- The contracting team sends the signed contract and onboarding materials to the provider. The team also passes this information to the network management team.
- The network management team activates the provider, starts onboarding, and keeps measuring network adequacy.