Network Participations

The guided workflows included with Provider Network Management help to effectively associate provider groups and their practitioners with a network. Provider Network Management also enables provider groups to organize their providers into specific tiers to create the network participation. These workflows help your users to easily associate the providers with a unique set of contracts and health plans.

For example, as a large national health plan, Cumulus Health Plans carries multiple networks, including an HMO, a PPO, and various Medicare offerings. As a final step in the contracting process, the contracting specialist must designate which network participation the new provider joins.

Network participations include these key components:

• Participating provider
• Network that the provider is participating in
• Location of practice that’s covered by the network
• Contract that binds the provider, network, and location together
• Period the network participation is active for

Both individual practitioners and provider groups can be participants in network participations.