Improved Provider Relations Starts Here

Enhance your ability to coordinate with the providers supporting your members and make an impact at the point of care.

Welcome to Your Provider Relations Toolkit

Care Team Collaboration Tools

Claims Submission & Replacement

Referrals & Authorizations

Appeals & Grievances

Benefit & Eligibility Check

Patient Profile 360°

Provider Scorecard

Proven Results

0 %

portal utilization among provider network

0 M

number of times a provider determined eligibility for a member through the provider portal

WEBINAR

Double Flu Vaccination Rates for Your Health Population

Our flu vaccination solution, built on an industry-leading behavioral study on vaccinations and by UPenn and Walmart, uses scientifically proven behavioral techniques and dynamic content to remove barriers and increase motivation.

Technology for True Partnership with Your Providers

Unlock Enhanced 360° Patient Insights

Make it easy for providers to perform key administrative tasks, such as member eligibility and benefit verification, check claims statuses, prior authorization pre-checks and submissions, electronically through your provider portal to overcome physician burden and reduce manual paperwork.

Reduce Provider Burden

Make it easy for providers to perform key administrative tasks, such as member eligibility and benefit verification, check claims statuses, prior authorization pre-checks and submissions, electronically through your provider portal to overcome physician burden and reduce manual paperwork.

Improve Provider Performance

Help providers understand and improve their performance against peer benchmarking by leveraging a portal-delivered provider scorecard, enabling health plans and providers to work collaboratively to close gaps in care, increase documentation of chronic conditions, and improve utilization.

CASE STUDIES

Better Conversations. Better Outcomes.

  • CASE STUDY 1
  • CASE STUDY 2
  • CASE STUDY 3

Provider Portal Utilization

Encourage wide-spread provider portal utilization through a Texas-based health plan

Goal:

Welcome and onboard Community First’s provider network, while driving engagement and encouraging ongoing utilization of available portal tools

Solution:

Community First provided ample notice to their provider network that a change to their platform was coming, listed out new features now available to providers, created a promotional video to get them excited about improvements, and made it a priority to drive providers to the portal for most interactions with the health plan.

Results:

80%

provider portal utilization

Provider Self-Service Tools

Goal:

Overcome poor provider satisfaction, create integrated communication, and develop a strong self-serve channel for provider interaction with health plan

Solution:

Implement and utilize mPulse’s provider portal to develop an automated, self-service model for the health plan’s provider network

Results:

96%

provider satisfaction rate with online services

35%

decrease in call volume to health plan service center

60%

decrease in average cost to work a claim

167%

increase in number of claims worked per FTE per day

Referral & Authorization Management

Goal:

Overcome heavy reliance on expensive and slow manual review process and workflow for referral and authorization request management

Solution:

Create an end-to-end authorization management process through mPulse’s portals and leverage the built-in rules engine to automate authorization request reviews and auto-approve based on the health plan’s current business rules

Results:

44

pp increase in online authorization submissions

45%

decrease in fax authorization submissions

Testimonials

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