Provider Network Setup and Administration
The healthcare market is continually evolving. Plans now require the ability to process claims and administer various forms of reimbursement based on an expanded set of provider data, including provider affiliations, fluid networks, alternate care sites and provider types and multiple program designations. In addition, Plans need the ability to guide their members for specific services based on this growing provider information.
Provider Management and Reimbursement (PMR) is a new mid-tier, Web-based provider data repository that contains a comprehensive set of attributes, including those not captured within other NASCO provider applications. PMR can be used by a Plan as its provider system of record or to feed data from the Plans’ existing system of record. To support this flexibility, PMR can receive data from a Plan using a batch upload process, plus it features a modern, user-friendly Web interface designed for ease of data maintenance. Plan-specific data configuration within PMR is made possible by user-maintained reference tables, which decreases maintenance costs.
These user-friendly and convenient features enable new products and programs that are dependent on complex provider arrangements to be launched more quickly.
In addition, PMR is tightly integrated with NASCO’s transaction systems, including membership, claims and non-claims reimbursement. This integration allows the transaction systems to readily reference complex provider relationships and statuses.