Provider Network Access & Development

Under these arrangements, HN1 is paid an administrative or an access fee for developing a network of providers or leasing its existing provider network to a health plan. Under these arrangements, HN1 could also be paid a bonus for any Part B and/or Part A Savings achieved or incur a financial penalty should Part B and/or Part A expenses increase or remain unchanged while under the management of HN1.

Under a network services arrangement, Payers often delegate some or all of the following administrative functions to HN1:

  • Network Development
  • Provider Relations
  • Utilization Management
  • Referrals / Authorizations
  • Claims Payment
  • Credentialing (optional)

HN1 would typically provide these management services to health plans that have recently entered a new market service area and do not have an existing provider network and/or do not have the internal resources to expand its existing provider network.

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