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 Medical Economics
Identification, Recruiting & Contracting Identification, Recruiting & Contracting
Access & Adequacy Reporting Access & Adequacy Reporting
NCQA CVO Credentialing NCQA CVO Credentialing
“Compliance and network management is not an easy feat for any managed care company, and TOG exceeded our expectations on every front. Their attention to detail, commitment to quality, and robust reporting are second to none in the industry.”
John Smith

President | Baystate Healthcare

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

Medical Economics: Your Market ROI Assurance

TOG’s medical economics services help health insurers make sound business decisions throughout every phase of the provider network market lifecycle. The value of these services translates into a combination of savings and increased profitability that earn the attention of top executives and shareholders alike.

  • Pre-network Entrance + Bid Phase

    TOG's medical economics division empowers health insurers with robust competitor benchmarking data. This in-depth analysis provides the insights needed to enter new markets confidently, ensuring predictable profit margins.

  • Build Phase

    The data from TOG’s medical economics division provides network contract negotiation guardrails, ensuring optimized, market-specific service rates designed to increase profitability.

  • Contract Delivery

    TOG offers medical economics services to study and reduce delivery costs by closely analyzing expense patterns and trends. From identifying which doctors are prescribing the most expensive drugs to costly procedures where more affordable interventions may exist, TOG is sharply focused on optimizing your bottom line.

  • Rebid Preparations

    The dynamic nature of the health care marketplace requires constant monitoring and evaluation. Before rebidding a government-payer contract, it is essential to reassess the provider landscape to ensure the prospect of continued profitability.

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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