The Challenge
Government – Network-Based
A full-risk plan looking to expand into adjacent counties needed:
- Assistance with provider network access to meet a looming filing deadline
- Selective access to providers post-filing, as needed to meet network adequacy requirements
The Solution
Claritev analysis identified providers under contract that could:
- Add immediate value for the filing process by filling gaps in the plan’s network
- Be accessed on an ongoing basis or until the plan could complete contracting efforts
The Results
Claritev contributed nearly 700 Medicare providers to the filing and credentialed 20% of the providers to enable ongoing access, helping the plan to:
- Meet its adequacy requirements for plan-to-plan contracts
- Successfully apply for a CMS contract in two of the counties
