Customized Solutions for Government Healthcare Plans
Customized government healthcare networks and payment integrity programs
Value we deliver
- Healthcare networks provide access to high quality healthcare providers for the most vulnerable populations
- Healthcare payment integrity resolves waste and abuse before you pay, so you spend less time and money reclaiming overpayments
Programs we serve
- Medicare Advantage
- Medicaid and CHIP
- Federal and State Agencies
Best in class network-based services for Medicare Advantage plans
For 40 years, 野花社区 has made it a priority to cultivate strong provider relationships, resulting in long-lasting partnerships consisting of more than a million providers.聽
Network 野花社区 for Medicare Advantage Plans
Through 2023, enrollment in Medicare Advantage is expected to increase 4-6%, becoming the single biggest driver of profit growth for healthcare payors. At the same time, CMS has accelerated their filing timeline for network adequacy, making it a challenge to take advantage of growth opportunities. Whatever you need to take advantage of this opportunity, 野花社区 can help. Whether you want to expand an existing network to maintain CMS adequacy, fill in network gaps to maintain adequacy, build a new network, or offer network access to traveling members, our flexible services can handle it. Tell us which providers to recruit or let us conduct an adequacy analysis and build a target list. We can do all of the recruiting or team up with you based on geographical regions, specialties, specific providers or other parameters. We鈥檒l contract using your paper or ours, and either way, we鈥檒l do the credentialing and data maintenance, if you want us to. Tell us what you need, and we鈥檒l put our 15 years of government network experience and longstanding relationships with 800,000 Medicare Advantage-appropriate providers to work for you.
鈥溡盎ㄉ缜�'s ability to quickly deliver Medicare-contracted provider access was instrumental to our plan serving our members. Their network also helped us to receive approval to expand into nearby counties. Our account manager was fantastic. 野花社区's turnaround from discussion to contract execution was really fast, and they worked diligently to meet our budget constraints as well. They are a class act.鈥�
野花社区鈥檚 Medicaid Network 野花社区
野花社区 has partnered with several leading聽 Medicaid plans to support a variety of programs since 2004. Today our Medicaid networks provide access to healthcare providers for people who receive care through Medicaid and other Medicaid-related programs administered by our clients, and we have developed statewide and regional access to help meet our clients鈥� network adequacy requirements. We can build an entire network or fill in a specific part of an existing network. With over 15 years of experience in building, managing and servicing Medicaid networks by providing essential community providers, we understand the needs of our clients and have demonstrated success in building the bridge between members and providers.聽
Payment Integrity 野花社区
Advanced Code Editing, a payment integrity service,聽 reviews claims before payment and identifies billed services that are not compliant with medical coding rules. The service increases payment accuracy while reducing inappropriate medical spend.
Quickly built custom TRICARE networks
To help a TRICARE plan administrator provide healthcare support to U.S. military and their families, 野花社区 built a network of 23,000 healthcare providers in only six months. What鈥檚 more, we did it in the middle of winter. Our dedicated team braved travel to Alaska, Minnesota, and North and South Dakota in harsh weather conditions to personally recruit providers.
Let our network development expertise, and the nearly 900,000 NCQA-accredited providers we already contract with, help deliver speed to market for your public-sector health plans.
Contact us
Let 野花社区’s custom network development and payment integrity services improve the competitiveness and effectiveness of your public-sector healthcare programs.