Network Development

Our firm’s expertise spans network development for Medicare and Medicaid replacement plans; C-SNP, I-SNP, D-SNP, ACA health insurance exchange networks, QHP; HMO, EPO, and PPO networks; IPA, government-funded programs; workers’ compensation; and specialized pediatric networks, including CHIP, Perinatal, and foster care programs.

Our consultants have a proven history of working together to negotiate contracts across all provider types. They bring extensive knowledge of value-based reimbursement, capitation, case rates, per diem payments, the Prospective Payment System (PPS), and other provider reimbursement methodologies.

Our team includes a four-tiered team of Consultants, Associates, Specialists, and Staff who manage the entire network development process from lead generation to recruitment, rate and contract language negotiations, document management, and contract fulfillment.

Assignments are aligned with each team member’s expertise to support effective execution and consistent service delivery.

A Broad Portfolio of Health Plans. Countless Provider Connections.

Aetna Better Health (CVS Health)

AmeriHealth Caritas

Arcadian Health

Bright Health

Community Health Choice

Elder Health of Texas

Equality Health

Focus Healthcare Management

Health Net Federal Services

Imperial Health Plan

Magellan Complete Care of Texas

Magellan Health

Molina Healthcare of Texas

Mount Carmel Health Plan

Oscar Health, Inc.

Provider Partners Health Plan

Smart Care of Texas

Texas Children’s Health Plan

Texas Independence Health Plan

Texas Professional Healthcare Alliance

Trinity Health Plan of New England

Trinity Health Plan of Michigan

XL Health – Care Improvement Plus

Zing Health Inc.

Zing Health of Michigan, Inc.

Extensive Reach. Many Markets. Experienced Team (State Listing)

Our Team - A Collaboration of Competitors

Embedded Consulting - White Label Services

We serve as an integrated extension of the health plan’s provider network team, representing the plan in provider outreach, recruitment, and contracting while aligning our work with its objectives, processes, and communication standards.

We use a dedicated email domain, @providernetworks.org, to provide a consistent, provider-focused point of contact for network development and contracting activities. This approach helps streamline communications, clarify our role in supporting the health plan, and facilitate contract completion.

Each health plan engagement is supported by a designated email address, along with dedicated street and P.O. Box mailing addresses. Mail can be forwarded to an address selected by the health plan at the conclusion of the project, supporting continuity afer a project with the firm ends.

Our Voice over Internet Protocol (VoIP) telephone system also allows us to establish local-market phone numbers with caller ID, as needed, to support provider recruitment and ongoing outreach.

Your network development team—an extension of your staff.

Salsforce Platform - Every Interaction Documented. Every Milestone Tracked. Progress Clearly Reported.

Our firm uses Salesforce, a widely adopted customer relationship management (CRM) platform, to support a coordinated, organized approach to provider network development and contracting. The platform brings together contact management, workflow creation, task management, opportunity tracking, collaboration tools, a shared knowledge base, customer engagement tools, analytics, and mobile-ready dashboards.

These capabilities help our team organize provider information, document outreach and communications, coordinate follow-up activities, and track contracting opportunities from initial engagement through completion. Shared records and defined workflows support continuity across team members, reduce duplicate efforts, and establish clear ownership of tasks and next steps. Collaboration tools and a centralized knowledge base also help staff share information and maintain consistent processes throughout an engagement.

For health plan clients, this CRM-supported approach promotes greater accountability and visibility into network development activities. Analytics and dashboards help our team monitor progress, identify potential bottlenecks, and prioritize outreach and contracting efforts in alignment with client objectives. Mobile-ready access allows team members to stay informed and responsive while working remotely or in the field.

By combining Salesforce’s capabilities with our team’s provider contracting expertise, we support a more efficient, transparent, and scalable approach to building and maintaining provider networks.

Call Center Services - The Capacity You Need. The Attention Your Providers Deserve.

For larger engagements with anticipated high inbound call volumes or dedicated provider services needs, our firm draws on its network development call center to provide additional capacity and responsive support. The call center serves as a centralized point of contact for provider inquiries, answering and triaging calls, directing requests to the appropriate team members, and scheduling appointments with Associates to help move contracting activities forward.

Located in Dallas, Texas, the call center provides English- and Spanish-language support from 7:00 a.m. to 7:00 p.m. Central Standard Time. This extended service window gives providers greater flexibility to connect with our team, while dedicated call handling allows Associates to focus on provider recruitment, negotiations, and contract completion. For health plan clients, this coordinated approach helps manage periods of increased call volume and supports continuity in provider communications.

Billing is based on actual call duration, measured to the second, with no rounding up to the next minute. For example, a 23-second call contributes only 23 seconds to the monthly usage total. At the end of each month, total call time in seconds is divided by 60 and billed at per minute rate, ensuring charges reflect only the call time used.

Visualize Your Network

Our mapping software transforms provider data into clear, visual maps that help health plans view provider locations across a service area.

Color coding by specialty makes it easy to distinguish provider types, while distance displays and zoom capabilities allow users to explore geographic relationships at the service-area, county, or community level.

The software can map prospective providers, contracted providers, or any provider list maintained in Microsoft Excel.

By presenting these records geographically, we help health plans visualize provider distribution, assess recruitment opportunities, and communicate network development priorities.

Ready to Close Gaps and Build a Network?

Connecting health plans with the providers and communities they serve.