Network Operations

A Network That Delivers

Your provider network is a critical competitive differentiator — members choose plans based on whether their doctors are in-network. Hetasalvation's network management specialists help health plans recruit, credential, contract, and retain high-quality providers while maintaining regulatory compliance and member access standards.

From NCQA-accreditable credentialing processes to provider data management and network gap analysis, we keep your network strong and compliant.

Discuss Network Management →

Network Services

Network Management Solutions

📋

Provider Credentialing

NCQA-accreditable credentialing and re-credentialing — primary source verification, committee review, and ongoing sanction monitoring.

Initial credentialing applications
Primary source verification (PSV)
Credentialing committee support
Re-credentialing (every 3 years)
OIG / SAM exclusion monitoring

🗺️

Network Adequacy Analysis

GEO-based network adequacy analysis against CMS, state, and accreditation standards — identifying network gaps before they become compliance issues.

Time & distance analysis
Provider-to-member ratio analysis
Specialty gap identification
CMS network adequacy reporting
Network development recommendations

🤝

Provider Contracting

Provider contract development, negotiation, and management — rate setting, contract templates, and systematic contract renewal management.

Contract template development
Fee schedule negotiation
Value-based contract development
Contract expiration tracking
Amendment management

🗄️

Provider Data Management

Accurate, current provider directory data — the foundation of claims accuracy, member access, and regulatory compliance.

Provider data collection & validation
NPPES / CAQH data integration
Provider directory maintenance
CMS provider directory compliance
Provider data governance

📞

Provider Relations

Dedicated provider relations that maintain strong relationships with your contracted providers — resolving issues fast and reducing provider abrasion.

Provider portal management
Provider education & training
Claims dispute resolution
Provider satisfaction surveys
Network retention programs

📊

Network Performance Analytics

Provider performance analytics — quality scores, utilization patterns, cost efficiency, and outcome measures that inform network management decisions.

Provider quality scorecards
Cost & utilization profiling
Network leakage analysis
Value-based performance tracking
Network ROI analysis

Provider Network Management