For Health Insurance Payers
Provider Network Solutions for Health Care Payers
Health insurance executives rely on TOG to define network strategy and success, identify and recruit provider networks, and deliver an end-to-end range of integrated network solutions, including NCQA CVO credentialing.
TOG Knows the Business
of Health Care
Industry leaders who value predictable bottom-line results rely on TOG's unmatched network intelligence solutions and market analytics. A recognized leader in the health care consulting field since 2010, TOG's data-driven approach, powered by its proprietary network intelligence platform, sets the company apart from any competitor.
Quality Provider Network Builds and On-Time Service Delivery
TOG is a multi-solution service provider with a sharp focus on building a strategic plan that complements your business goals. In addition to building the best provider networks, TOG offers a full suite of payer-focused services designed to enhance your bottom line.
Network Analysis and Strategy
From scrutinizing network information to finding the correct resources, TOG Network Solutions uncovers opportunities and tactics designed to maximize revenue and optimize quality health care delivery for the health insurance industry.
Network Intelligence
TOG is the only health care provider network builder with a network intelligence division that supports the entire network operations lifecycle.
Provider Recruiting, Negotiating, & Contracting
TOG Network Solutions builds all types of networks, including commercial/self-funded, QHP/Exchange, Medicaid, Medicare, and military. TOG's highly experienced recruiters and contracting specialists have well-established provider connections in every local market. This has allowed TOG to build an extensive portfolio of successful health care provider network builds spanning nearly every corner of the United States.
What Can Network Intelligence Do For You?
When applied to health care provider networks, network intelligence examines the interplay between economic forces and the structure, function, and profitability of health care provider networks. It provides the data necessary for insurers to decide whether to enter a new marketplace, negotiate effective rates with providers, and optimize profitability while delivering the highest quality patient care.
Provider Data Management
TOG offers the market's most precise Provider Data Management Platform, expertly designed to deliver actionable insights to build better and more efficient provider networks, saving payers significant time and costs.
Credentialing
TOG ensures all network providers meet stringent credentialing standards, maintaining high-quality care through comprehensive, rigorous verification of qualifications and strict compliance with industry regulations.The Industry's Most Precise Data Management Platform
TOG Network Solutions’ Provider Data Management Platform empowers health insurers to effortlessly build and maintain networks, eliminating costly configuration and credentialing errors.
The proprietary single-source platform eliminates redundancies, increases transparency, and integrates seamlessly with claims, credentialing, and analytics systems. It also functions as a provider services CRM tool seamlessly connecting to insurer claims, credentialing, and analytics.
Deeply Skilled Team
TOG’s senior leadership team, comprised of former health insurance industry executives, brings invaluable insights into the unique challenges payers and provider network managers face. This insider’s perspective allows us to anticipate your needs, develop innovative solutions, and streamline processes.
Sustainable Network Builds that Pay for Themselves
TOG is the only health care provider network builder that offers payers a definitive picture of their expected return on investment before provider recruitment and contract negotiations even begin.
The clarity of a sound profitability forecast allows payers to optimize network performance and enter new markets with confidence. The application of this data allows most health care plans to recoup the cost of their network build within the first year of service operations.
Case Studies
Medicare & Medicaid Network Adequacy
A network build covering provider specialty and facility types in accordance with health service delivery (HSD) adequacy requirements for Medicare and state Medicaid.
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Exceeding CMS Adequacy Requirements
A lightning-fast network build that exceeded the 90% CMS adequacy requirement.
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