Provider Network Management Data Model

The provider network management data model provides standard objects and record types for provider data. This data includes the provider application, credentialing, and contract payment terms.

With Provider Network Management in Health Cloud, providers can apply to join a network. Credentialing specialists can then validate information such as the education qualifications, certifications, and employment history to enroll providers into the network. Contracting specialists can then define appropriate payment terms for contracts associated with provider networks.

Provider Network Management is available in Enterprise and Unlimited editions of Health Cloud provisioned with the Health Cloud Provider Network Management Add-On license.

Note

The provider network management data model includes standard objects and record types on standard objects. You can use these objects to model your organization’s work flows as you manage provider application and credentialing data.

Provider Network Management includes these objects:

Application Case: A junction object that associates a case with a provider’s application.
Bundled Care Fee Agreement: Represents the payment terms for contracts of Bundled Care Fee Agreement.
Business License: Represents the licenses of a provider applying for enrollment.
Capitation Care Fee Agreement: Represents the payment terms for contracts of Capitation Care Fee Agreement type.
Care Fee Schedule Item: Represents procedure level fees for a fee schedule definition.
Care Provider Adverse Action: Represents any adverse actions against the provider, such as malpractice lawsuits or revoked licenses.
Care Specialty Taxonomy: Represents a static list of specialty taxonomy codes.
Care Taxonomy: Represents a static list of taxonomy codes.
Categorized Care Fee Agreement: Represents the payment terms for contracts of Categorized Care Fee Agreement type.
Contract Payment Agreement: Represents information about the contract payment agreement associated with a contract.
Fee Schedule Definition: Represents fee schedule information for contracts of Standard Care Fee Agreement types.
Healthcare Payer Network: Represents different networks in your organization.
Healthcare Facility Network: Represents the network a facility is a part of, and the providers at that facility within the network.
Individual Application: Represents an application form submitted by a provider.
Insurance policy: Represents the type of insurance policy associated with the provider.
Percentile Based Care Fee Agreement: Represents the payment terms for contracts of Percentile Based Care Fee Agreement type.
Person Education: Represents information about educational qualifications of a provider applying for enrollment.
Person Employment: Represents information about employment history of a provider applying for enrollment.
Preventive Care Fee Agreement: Represents the payment terms for contracts of Preventive Care Fee Agreement type.
Provider Network Contract: Represents a network participation bound by a contract.
Provider Network Tier: Represents the tier a network belongs to.
Shared Saving Payment Agreement: Represents the payment terms for contracts of Shared Saving Payment Agreement type.
Standard Care Fee Agreement: Represents the payment terms for contracts of Standard Care Fee Agreement type.

For detailed data model documentation, see the Health Cloud Developer Guide: Provider Network Management.

Health Cloud Administration

Provider Network Management Data Model