Department 4: New Provider Empanelment and Provider Rate Card Renewal

Existing Ancestral Provider Empanelment Process

Problem
  • • Long Provider Empanelment and Provider Rates Benchmarking Time.
  • • Benchmarking Providers across similar Provider rates is a tedious error prone and time-consuming task.
Average Time taken to empanel a provider 15-20 days.
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    Step 1

    Provider Proposes the Rate for each of the services over mail

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    Step 3

    Network Pricing team manually computes the impact on Net Payout (increase) due to revised or new provider rates.

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    Step 5

    Once the Provider Negotiations are done, Team manually uploads the rate card into the system.

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    Step 1

    Provider Proposes the Rate for each of the services over mail

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    Step 2

    Network Pricing team compute in excel the rates of benchmark providers (similar vicinity and cost)

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    Step 3

    Network Pricing team manually computes the impact on Net Payout (increase) due to revised or new provider rates.

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    Step 4

    Network Pricing Team get approvals from the management on the proposed rate card to ensure the increase in claim payout is within the acceptable standards.

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    Step 5

    Once the Provider Negotiations are done, Team manually uploads the rate card into the system.

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    Step 6

    In case of multiple negotiations between Provider and Insurer, the Team performs Steps 1-4 steps again until the desired negotiations are met.

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    Step 2

    Network Pricing team compute in excel the rates of benchmark providers (similar vicinity and cost)

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    Step 4

    Network Pricing Team get approvals from the management on the proposed rate card to ensure the increase in claim payout is within the acceptable standards.

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    Step 6

    In case of multiple negotiations between Provider and Insurer, the Team performs Steps 1-4 steps again until the desired negotiations are met.

How the Provider Empanelment process get revolutionized with MedML

90% REDUCTION in Process Time and reduced risk of errors in benchmarking.

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Submit Service Rate Card (as a provider)

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Our Al benchmark rates with peer providers and acceptable net impact!

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Our Al will suggest areas of peer excellence, roll-out custom SOPs in seconds that help in informed Provider Management

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If all seems good our AI will Empanel Provider & Revise Contract in seconds.

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Otherwise, our AI allocates your case to Human Intelligence to discuss on proposal as soon as possible.