Workflow · Employee Health & Benefits
Network Comparison
Compares candidate carrier networks against the providers a client's members actually use, so the access question is answered before a carrier decision: each utilized provider is checked against each network, disruption is measured both by provider count and weighted by visits and claims dollars, and every network gets a clear verdict with the deciding fact shown.
What goes in
A provider utilization extract for the current period — provider name, specialty, the members or member count seen, visits, and claims dollars — plus the network materials for every candidate network: a carrier directory extract, a carrier-run disruption report, or a network roster. Optionally the plan documents stating out-of-network and tier terms, any carrier geographic-access report, the client's must-keep providers or facilities, and any stated access standard.
What you get
A Network Comparison Report as a native Word document: executive summary with the mode and verdicts, the networks compared, a provider disruption summary table with the match rates and member impact per network, provider-level findings, facility and hospital system access, geographic access as stated, member cost impact, continuity-of-care provisions as stated, the per-network verdict with the rule applied, data gaps and requests, and a source register.
How it works
- 1Establish the comparison: confirm the networks in scope, the incumbent, the client's must-keep providers, and any access standard, then upload the utilization and network files.
- 2Extract the evidence: utilized providers are pulled with their specialty, visits, and claims dollars; each network with its type, breadth, tiers, and out-of-network terms.
- 3Determine participation: every provider is matched against every network — in network, in network at a different tier, out of network, or not determinable from the files provided.
- 4Quantify the disruption: provider match rates, utilization-weighted match rates, members affected, and disrupted claims dollars are calculated for each network.
- 5Judge and deliver: each network receives a verdict — acceptable as quoted, acceptable with transition of care, or not acceptable — in one Word/PDF report with the deciding facts shown.
Related pages
What this workflow delivers
A Network Comparison Report as a native Word document: executive summary with the mode and verdicts, the networks compared, a provider disruption summary table with the match rates and member impact per network, provider-level findings, facility and hospital system access, geographic access as stated, member cost impact, continuity-of-care provisions as stated, the per-network verdict with the rule applied, data gaps and requests, and a source register.
4+ hours
- Guided step by step, no blank page
- Owners and follow-up on every run
- Human review before sign-off