The purpose of the Network Development and Provider Relations Department is to set up and maintain a network of health providers. Therefore, aside from recruiting new providers and assisting Senior Staff in developing and expanding the provider network, this department also familiarizes the providers with Health Plus programs and keeps them up to date on vital information. This is done through the production and distribution of the Provider Manual, the Provider Directory and the Provider Newsletter.
Aside from distributing informational material, close contact is kept with the providers and with their staff. It is important to be sure that all providers understand the plans and that any questions they might have about claims payments, member enrollment issues or program changes are answered in a timely fashion. Any common problems with claims are also identified.
This department must also respond to complaints made either by the providers about the members or by the members about the providers.
In order to maintain a quality of service, the department conducts surveys of available office hours, numbers of appointments, and accessibility. Surveys are also conducted on member satisfaction, as well as grievances and complaints. When, for whatever reason, a provider does not meet our standards, the department, with input from the Chief Medical Officer, will work with the provider to develop and implement a corrective action plan.
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What is Health Plus?
