Network Q&A with Anitha McNeilly

Become a health plan of choice

As a health plan, you have contract obligations to meet and compliance regulations to abide by. Typical provider management systems are designed for healthcare systems and medical groups - not health plans like yours. This leads to headaches for you and poor experiences for your patient and provider members. Network by VerityStream was created to directly address payer needs in terms of credentialing and provider data management for your networks.

We recently sat down with Anitha McNeilly, VerityStream Senior Product Manager, to learn more about Network. A summary of our chat follows.

Q: What is Network?

A: Network is a VerityStream solution designed specifically for health plans. Network supports a health plan system's membership needs which includes credentialing and provider data management. With Network, health plans get a one-stop shop for solving the unique challenges related to network management. This includes delivering provider network adequacy, directory accuracy, seamless provider onboarding, while staying in compliance with industry regulations.

Q: Why was the solution created?

A: First and foremost, it was created with current customers in mind. We observed that an increasing number of our health system clients began to offer health plans and with this they became responsible for developing and managing their own physician networks and payer credentialing processes. They needed a solution to do this, so we built one.

Second, we see that as the way we work changes - meaning more remote working - more and more health plans need to expand their coverage across state lines. As such, health plans are extending their footprint across multiple states to support their beneficiaries regardless of what state they reside. Meeting multi-state health plan licensure is challenging and requires a solution like Network to do it.

Finally, we know that industry regulations are only going to get tougher in the years ahead. New initiatives like the No Surprises Act mean new expectations for health plans in terms of maintaining accurate provider data. Network helps them with that.

Q: Who is the solution for?

A: It's a fit for any payer - whether that be a health plan that operates in a health system or an independent health plan with a focus on a payer's need for credentialing tools in addition to network management.

Q: Who is the solution not a fit for?

A: The solution is tailored to health plans often referred to as payers. Health plans are unique in the sense that they are a magnet for provider data. They have a lot of data to intake and manage. This solution is not for health care organizations that are looking for a provider enrollment solution which involves sending out provider data and enrollment with payers.

Q: Does a health plan need to have CredentialStream to utilize Network?

A: Network is additional available that integrates with CredentialStream. CredentialStream includes everything you need to request, gather, and validate information about a provider to create a Source of Truth. Network taps into that data and allows health plans to manage and monitor a provider network.

Q: How is the solution priced?

A: The solution is built to be affordable and scalable depending on a health plan's needs. Cost is based on the number of providers in the network.

Q: What does the VerityStream Network product's typical implementation look like?

A: Once a customer has CredentialStream in place, adding Network usually takes about 6-12 months which is dependent upon the complexity of a health plan network as well as health plan resources to support the implementation. As with all of our solutions, our team will work side by side with your team to help you adopt and configure our content to match your current operating procedures, determine how best to implement the power of Network, and be sure it's a success for you.

Q: What does a company risk by not using Network?

A: There's a lot to lose without the automation that Network delivers. First off, manual processes and workarounds waste a lot of time. Second there are countless risks involving network inadequacy, outdated provider directories that can result in fines, and service issues that result in dissatisfied patients and providers to name a few.

Q: What are some of the benefits users enjoy?

A: With a solution like Network, ongoing health plan membership growth, credentialing and provider data management that is supported with automation. This saves a lot of time and ensures that things are done right. You get a consolidated single source of data that is reliable and keeps the end deliverables in mind that includes network adequacy and accurate provider directories. Health plans that use Network emerge a health plan of choice!

Sign up to meet your Network guide here.