Match to the right specialistScope, availability, and network data prevent delays and after-hours care.
Maximize the value of your provider network
You built a great roster. Don't let the wrong game-time decision undermine it.
Reduce avoidable costsRefer to high-value, low-cost specialists with fewer delays.
Design better networksGain unprecedented visibility into specialist insights.
Retain your membersGive members faster, cleaner specialty access.
Prevent access issues before they turn into expenses
Route members correctly before referrals are kicked back, delayed, or fall through.
Optimize for cost and qualityPair cost and outcomes data with operational insights and referral need.
Submit auths right onceClinic-specific auth requirements reduce staff and UM rework.
Use your network better
Fewer delays. Less rework. Lower avoidable cost.
See where your network actually works
See access gaps, provider performance, and where network teams should intervene.
Provider relationsUse evidence to guide your conversations.
Network strategySee and fix network gaps and weaknesses.
Network access intelligence
Cost Discrepancy
PT costs vary widely in San Diego County. Refer to lower-cost clinics when appropriate.
Surgical Gap
No in-network lumpectomy access within a 1-hour drive of ZIP 92562.
Wait-Time Risk
Orange County GI clinics average 48 days to next appointment.
Closed Location
A listed dermatology location is closed; members must wait 3 months and travel 45 minutes.
Prior Auth Rework
25% of ophthalmology clinics require unlisted CPT changes.
Improve member experience
Referrals are a common source of avoidable friction.
Getting Appointments and Care QuicklyRefer to providers with sooner availability.
Getting Needed CareMake scope-matched, faster referrals.
Complaints about the PlanReduce grievances by preventing referral issues.
Member RetentionReliable access builds trust and reduces attrition.
Rating of Health PlanImproved access leads to an improved rating.
Rating of Health Care QualityBetter referral matches improve care quality.
Health Plan Quality ImprovementShow measurable year-one improvement.
Quality Bonus PaymentsCAHPS improvement increases revenue.
Reduce costs while improving access and retention
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