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Provider Network Management

As clients are referred through an array of service Providers, it has become possible to track and maintain control of the process, particularly funds encumbered through services, using ProviderGateway™. Using an online billing module, contract administration problems such as exceeding budgets and under spending are prevented, while critical compliance information is compiled according to each program tracked in the ProviderGateway™ network. 

ProviderGateway™ extends the case-management and billing infrastructure to external providers by enabling the coordinating or funding agency to:

  1. Track service outcomes and total cost of services on an individual client basis or in the aggregate.
  2. Effectively manage and reconcile multiple funding sources simultaneously with complete reconciliation.
  3. Monitor Provider contract utilization in order to prevent overspending, and identify under-spending early in the program year or period
  4. Expand case management capabilities and improve service coordination between Providers and Client service professionals on a real time basis. 
  5. Decrease paperwork associated with Provider referrals, service authorization, invoicing, charge processing and post service audits
  6. Create a complete and detailed audit trail of every financial transaction associated with Client services in one or multiple programs on a demand basis
  7. Interface with internal account payable & billing systems. 

How it works:  

ProviderGateway™ maps easily to internal programs beginning with the setup of providers and the details of agreements, MOU’s and contracts, through to service delivery in multiple programs concurrently. ProviderGateway™ does this by:

Maintaining a charge/service taxonomy related to funding sources based on your organization’s services directory and chart of accounts.

  1. Maintaining fee-catalogs and charge structure reflected in live/current provider contracts 
  2. Supporting on-line service delivery and service coordination management for multiple programs as clients are referred throughout the provider network
  3. Tracking service authorizations based on program eligibility, case management, budget and contract parameters
  4. Tracking service outcomes, encumbered charges and provider invoices 
  5. Supporting provider invoice/charge review, audits and funding source reconciliation.

Results: 

In the same system, up to the moment information is available for program and fiscal personnel, ensuring better monitoring of clients receiving Provider services. Case management and outcome information is available to access-qualified professional staff for all services provided to a client over an episode of care, a program year or on a historical basis. 

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