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Provider Network Verification (PNV)

We developed our Provider Network Verification system to allow our clients to monitor health plan compliance with provider network requirements. PNV includes a secure web portal for our client and the health plan. The portal allows the health plan to submit provider network data, research potential providers, access and review file history, participate in online discussions, request assistance from client staff, and access announcements and extensive reports. PNV enables our clients to post relevant announcements, identify the provider capacity for targeted areas, review and approve providers based on relevant conditions, and access the tools available for the health plans.

The PNV portal provides in-depth information about the program to assist with decision making and network monitoring.

Not only does PNV provide additional useful information for both the state and the health plan, it elevates the program higher in the MITA maturity model. The PNV portal offers extensive benefits to the state and health plans:

  • Increased assistance to the health plans in terms of monitoring their networks.
  • Increased ability for health plans to best determine areas to prioritize for provider participation.
  • Unprecedented transparency to the state in terms of monitoring network activity.
  • Tools that will help both the state and health plans decrease the administrative burden associated with network monitoring.
  • Enhanced ability for health plans to troubleshoot and resolve issues with their provider networks before they become larger problems.
  • Enhanced ability for the state to monitor for fraud and abuse.
  • Increased sense of community and accountability for all parties.
  • Support for advancing MITA maturity.

“Working for AHS has given me a different perspective and better understanding of how important customer service is. Providing great customer service cannot only impact someone else’s life, but can also help you grow as an individual. Thanks to AHS, I have now developed exceptional customer service skills and great opportunities to excel within the company.”

Candice Vaughan (TN)