Work with provider network

Is it necessary to build a relationship with your network rep? After all, their primary role is to serve as intake & resolution for provider concerns. Right?

Many providers view this role as streamlined customer service. While there is some truth to this, it is a gross generalization. Realistically, the network representative is essentially your gatekeeper to the entire company. This is your assigned contact within the organization to help navigate the health insurer’s inner workings. When you need to report issues or have questions about contracting, network guidelines, payment, or any question that starts with “How do I…”, the network representative is the role charged with answering them or working with the appropriate area to resolve them. When you think about it in those terms, it’s worth your while to leverage this position to your advantage. Below are my recommendations to develop the best working relationship with your network rep.

Identify The Preferred Method Of Communication For Reporting Issues

Ideally, it should be a method that’s electronic and trackable by both parties. The goal here is to have a way to make sure that your network representative is aware of any issues, without your office having to pick up the phone to report each one. Agree on timeframes to acknowledge receipt of the issue(s), servicing, and status updates. Do not submit anything where there is already a defined process for resolution – i.e., appeals.

Schedule Routine Meetings

There are 2 types of meetings you should have at regular intervals. For each meeting, document and share the takeaways and expected timeframes.

Status Meeting. Use this time for both you and your network rep to discuss, in detail, the status of issues you have reported. The frequency of these meetings will depend on how often you encounter issues where you need to involve your network rep. At a minimum, touch base every other month.
Update Meeting. The purpose of this meeting is to exchange information, create valuable dialogue, and establish a good rapport. Do not use this time to discuss your reported issues (from #1). Set an agenda & stick to it. I suggest meeting once a month, for a maximum of 30 minutes. Topic suggestions – new communications sent by the Plan, are there any relevant changes to workflow processes that would impact your office or the Plan, technology updates, best practices, trends, your “how to” questions.

Quarterly Updates

Quarterly, set time for your network representative to review newly implemented policies (Claim Payment, Medical Policy, company updates, system changes, the Plan’s portal) that will directly impact your business. You can also use this time to ensure the Plan has a current Physician roster or review your office’s fee schedule. For the quarterly meetings, I suggest meeting for an hour. These meetings should have a great deal of content and you should walk away having learned something. Set clear objectives for each meeting, making sure that the agenda has been shared 1 week before the meeting. This will allow time for the rep to prepare.

Know The Hierarchy

Set a regular appointment with your rep’s next level management twice a year. This also helps to keep you and your concerns on the radar. One of the 2 meetings should occur toward the end of the year. Be sure to mention when your network representative is doing well, if they are meeting deadlines, successes, as well as things that are taking longer than expected to resolve. This goes a long way in ensuring that you continue to get a quality service experience. If your network representative is not meeting your expectations, express that concern to the coordinator first. If that is unsuccessful, escalate to their immediate supervisor and state your expectations.

Handy tip: Track Results!

Keep a running list & updated status on the work with your network representative. Segment by meeting type so that you’ll be able to easily identify the reported concerns, responses, and informational conversations. Not only will this help you see what’s outstanding, but it will help you stay on track during your meetings.

By connecting with your network representative regularly, you will find that you’ll actually save time and accomplish more than you would if you only reach out to report problems. The objective is to maintain communication that will position your office to get ahead of potential issues and create an efficient, dedicated process to resolve concerns. When it comes to getting problems addressed – or avoiding some altogether – I’ve found that the most successful practices were those that took the time to cultivate a relationship with their network representative.