Health Care Provider Network Builds + Strategic Services

Eliminate compliance risks and build a better network
with TOG Network Solutions.

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Tailored Solutions for Every Payer Need

TOG Network Solutions is the most trusted name in the health insurance industry for building provider networks and delivering integrated strategic solutions spanning a wide range of bottom-line-driven services.

Network Strategy Network Strategy
Medical Economics Network Intelligence
Identification, Recruiting & Contracting Identification, Recruiting & Contracting
Access & Adequacy Reporting Access & Adequacy Reporting
NCQA CVO Credentialing NCQA CVO Credentialing
“This is the best thing about a Specialty group like TOG- they have true experience, and professional Network people that are capable at every level you need.  They have real Network experience.”
Pam S.

President | major health plan

Network Strategy: Building with Purpose & Precision

A sound project strategy is required to achieve network adequacy in concert with an on-time and on-budget network build. That begins with a detailed targeted provider and health system assessment to identify contracting opportunities with the greatest potential impact on your overall network adequacy. TOG then pressure tests this provider data to measure network adequacy and refine your network development strategy accordingly.

You can rely on TOG to continuously monitor and analyze your provider network throughout all phases of the project lifecycle, ensuring network adequacy is not only achieved but also maintained in alignment with your profit margin goals.

  • Proven Project
    Planning Capabilities
  • Targeted Provider
    Prospecting Skills
  • Expertise in Achieving
    Adequacy Requirements

Network Intelligence: Your Market ROI Assurance

The TOG Network Intelligence Platform unifies all six critical dimensions of the network lifecycle, from strategic positioning and cost & contracting to access & quality.

  • Strategic Positioning

    Future-proof your growth and align your network with your market strategy, competitive goals, and targeted segments. We measure alignment with service-area priorities and share of high-value providers to drive strategic growth.

  • Cost & Contracting

    Master your medical spend by instantly analyzing your unit cost variation, contract efficiency, and percentile positioning versus market rates. We pinpoint where to negotiate smarter to optimize your total medical expense (TME).

  • Breadth & Depth of Network

    Optimize your coverage and capacity by balancing network scale and essential redundancies. We measure the comprehensive range of provider types and specialties to ensure you have the right density without unnecessary cost duplication.

  • Access & Availability

    Guarantee member access by proactively monitoring time, distance, and appointment availability to ensure timely, geographically sound care. We verify compliance against CMS and NCQA standards to eliminate adequacy risks.

  • Quality & Performance

    Drive clinical outcomes by measuring the effectiveness of your providers using key metrics (STAR, HEDIS). We track readmission rates and avoidable ED use to ensure your network is delivering high-quality, evidence-based care.

  • Member Experience & Choice

    Elevate satisfaction and rention by understanding how members perceive and use your network. We analyze CAHPS, NPS, and provider switching rates to ensure ease of navigation and a high-quality in-network choice that keeps members loyal.

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Provider Identification,
Recruiting & Contracting

Your network is built by a team of seasoned hospital, physician, ancillary, and behavioral health recruiters and negotiators who prioritize fostering collaborative relationships with providers and health care organizations. TOG consistently delivers favorable reimbursement terms, ensuring cost-effectiveness and access to an adequate and accessible network.

Access & Adequacy Reporting

TOG navigates the complex health care landscape for you, ensuring your payer networks and providers not only meet but exceed all compliance standards. Our powerful suite of analytics and advanced reporting tools provide the insight necessary for targeted provider prospecting, focused contracting strategies, and ongoing network adequacy monitoring.

  • Provider Credentialing

    Ensure providers are properly licensed and have the required qualifications.

  • Data Accuracy

    Maintain up-to-date provider information, including addresses, specialties, and board certifications.

  • Billing & Coding

    Follow established coding standards and billing practices to prevent fraud, waste, and abuse.

  • Quality Standards

    Meet or exceed quality metrics set by your health plan or other regulatory agencies.

NCQA CVO Credentialing

TOG’s rigorous Credentials Source Verification process ensures compliance with NCQA accreditation standards, industry regulations, and legal requirements. Outsourcing the credentialing source verification process to TOG ensures your network providers are quickly credentialed and re-credentialed.

  • Reduce Administrative Burden
  • Streamline Operations
  • Save Time and Money

Optimize Your Health Plan’s Provider Network with our Comprehensive Guide

A high-performing provider network is essential for a successful health plan. It can help you attract and retain members, improve quality outcomes, reduce costs, and bolster financial performance. Moving to a more productive provider network can be a complex and time-consuming process.

TOG’s comprehensive guide will help you navigate the provider network life cycle and achieve your performance goals.

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