Today’s payers are still adjusting to the significant operational and transparency changes as a result of the No Surprises Act and Consolidated Appropriations Act. These mandates put the provider network operation on the front line and at the eye of the storm of some pressing market conditions—from the regulations to escalating, costly labor challenges and damaging provider abrasions that can easily build to member abrasions. The inherent network database inaccuracies shouldn’t be underestimated as just operational and physician satisfaction bottlenecks. These discrepancies can prevent patients from accessing the care they need, leading to poor health outcomes and satisfaction levels. Additionally, the spotlight is now even brighter with recent No Surprises regulations requiring providers and payers to keep patients informed about the costs of care and their personal financial responsibility throughout the care journey.
The race to respond is on and health plans are now completely rethinking the fulcrum point of provider network operations so they are both strategic and sustainable. To help address this need and fortify a reliable provider network, many health plans seek provider network management tools to facilitate provider data operations that will improve accuracy for enhanced provider and member experience while delivering significant cost savings.