PRISM utilizes state of the art analytical tools to assess the value of a provider network, or the comparative values of multiple provider networks. The assessment can target network negotiated fees, network access with current utilization patterns and steerage capability.
Benefits
Ø Determine if one or more provider networks provides adequate coverage for a member population.
Ø Assess the effectiveness of a provider network relative to covered benefits.
Ø Determine if a network has cost effective providers.
Ø Compare relative negotiated fee levels.
Ø Identify current provider utilization patterns by members.
Ø Evaluate if a specialty carve out network is needed for certain services.
Provider Network Analysis Services
Ø The client specifies the dimensions of the provider network analysis.
Ø Client specifications determine the comparison of data.
Ø The initial report provided explains the analysis and makes recommendations.
Ø Ongoing access is maintained to reporting capability to analyze the network chosen.
Process
Ø Obtain provider lists and negotiated fees from networks.
Ø The client or administrator provides claims data for a one year period.
Ø Data is mapped into a sophisticated analytical system.
Ø Initial and ongoing reports are generated.
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