Claritev’s Network-Based Services
Flexible healthcare provider networks for payors
Our healthcare provider networks at-a-glance
Types of networks
Available for commercial, Medicare Advantage, and Property and Casualty healthcare payors
About our networks
- National primary PPO network (including our nationwide PHCS Network that is NCQA-accredited for credentialing
- Select regional primary networks
- Complementary “wrap around” network
- Specialty networks
Customizable
Innovative contracts add value for all types of health plans
How we customize our networks
- Extended access for members who travel or live away
- Blended access to fill gaps in a plan’s own network
- Subset networks for unique plan designs
- Custom network builds for specific populations
Quality and service
Over 40 years of experience
About our quality and service
- NCQA-Nationally accredited primary PPO (PHCS Network), all others use the nationally recognized standards
- Network contracting strategies guided by data analytics
- Pre-payment integrity services are embedded in our networks to correct improper billing
- 98% of participating providers are contracted directly
- >100 network development professionals across the country
Our healthcare provider networks in action
Networks are becoming narrower and more value-based, but consumers and regulators continue to demand access to in-network providers wherever and whenever care is sought. Claritev contracts with over 1.4 million healthcare providers and facilities to add value to any healthcare payor’s network access strategy. Read how a regional provider-owned health plan extended primary network access for its membership.
By the numbers
5,600 hospitals
164,000 ancillaries
1,400,000 providers and facilities
The PHCS Network: a national NCQA-accredited network
Claritev’s PHCS Network is the only national independently-contracted primary PPO network to have been accredited by NCQA for credentialing – a status we’ve held continuously since 2001. The PHCS Network is available in a variety of configurations including outside the plan service area, to extend local HMO or PPO coverage nationally.
NCQA has reviewed and Accredited the PHCS Network’s Credentialing functions only. For complete details on the scope of this review, visit www.ncqa.org
Ensuring provider data quality
Provider self-service
Encouraging routine updates to ensure data quality
Predictive data cleansing
Through sophisticated data mining
On shore outbound call center
Staffed by full-time employees
Get in touch
Are you a healthcare payor looking for more information on our provider networks?
