Network Operations & Care Delivery Management

Provider Network

• Provider Communications
• Directory Accuracy and Suppression of Unverified Provider Information
• Primary Care Providers
• Specialists
• Local Care Units (LCUs)
• Facility Care Services
• Selected Provider Networks
• Clinician Credentialing and Recredentialing
• Facility Credentialing and Recredentialing
• Practice Site Standards
• Limited Service Provider – Retail Medicine
• Urgent Care & Walk-In Providers
• Tiered Provider Network Review Guidelines

Provider Network: Performance Standards & Expectations

• Home DME & Oxygen/Respiratory Care
• Home Health Care Providers
• Hospice Care
• Inpatient Acute Rehabilitation Hospitals, Sub-Acute & Skilled Nursing Care Facilities

Care Delivery Programs

• Care Management
• Centers of Excellence Program
• Clinical Decisions
• Denials and Adverse Determination
• Prescription Drug Management
• Utilization Management