Our Solutions

Health Network One manages a broad range of networks, delivering outsized impact to more than three dozen managed care organizations. Our selection as a partner is driven in equal parts by our value-based solutions, our clinical expertise, and our bulletproof operations.

Typically, we are delegated Claims Management, Credentialing, Provider Network Management, and Utilization Management. And typically, we are designated as a top vendor performer by our health plan customers in each of these areas and more.

As much as we'd like it, we recognize that you may not need to delegate all of your ancillary networks. However, for the ones that you do, you'll require a partner that's as deeply committed to the health plan's mission - operationally, clinically, and financially - as you are. Health Network One is exactly that partner.

While the word 'network' is literally our middle name, Utilization Management and the alternative payment models it enables, is our soul. This key function represents innumerable moments-of-truth for members and providers. More than 1/3 of our employees are dedicated to this essential function. And unlike traditional vendors, our goal is find pathways to approve nearly every authorization request. In fact, in outpatient therapy for example, our denial rate is below 1%.

We are committed to excellence in our operations. We are NCQA-accredited for Utilization Management and Credentialing. Recently, we were recognized by Healthcare Business Review as a Top 10 UM Solutions Provider. We are also HITRUST certified, ensuring we meet the highest standards to protect and manage health plan data.

To ensure maximum flexibility and scalability, we built a custom back-office platform called GDS. This industry-leading tool allows us to create health plan-specific configurations that work, rather than trying to match up square pegs and round holes. The results speak for themselves. We are routinely recognized as a health plan's #1 vendor performer with metrics such as 99.75% encounter acceptance rates and claims turnaround times nearly 3x the statutory requirements.

GDS also extends to the provider, allowing them to process truly paperless authorization requests through the inclusion of attachments. Providers can track authorization progress as well as claims payment progress too.

We strive to exceed the stringent performance standards imposed by CMS, state Medicaid agencies, and our clients. We are successful because our technology platform enhances our already robust capabilities.

Our perspective is simple: providers are the beating heart of care. We view them as essential partners, not only for our success, but for yours.

Our philosophy follows our perspective. We are hands-on, always looking for ways to enable our providers' success. For example, in outpatient therapy, we meet with every provider in person, at least once a year. And every provider is contacted once per quarter. Those standards are unheard of in ancillary networks.

And we go further. In each state we maintain active Medical Advisory Committees that meet quarterly with our senior leadership, providing direction and on-the-ground insight that can only come from practicing providers. We also produce report cards and we offer performance bonuses.

A satisfied, expansive, and stable provider network ensures continuous and accessible care for members, a key driver of their satisfaction and yours.

A photo of a child using a stethoscope on a doctor

Network Solutions

We have three main network divisions: Outpatient Therapy, Eye Care, and Specialty Networks. Each one is managed under full risk and employs a range of Alternative Payment Methodologies that deliver medical and administrative cost savings while enhancing clinical quality through our innovative programs.