The Provider Platform
Reach new markets
and new members on your terms
OpenNetworks is a technology platform facilitating transparent, predictable, and simple business arrangements between healthcare providers and purchasers such as employers and third-party administrators. OpenNetworks is not another health plan. It is not a narrow network. It gives you new control over your business.
Provider Resources
Guides and answers to help you work with OpenNetworks.
How It Works
How the OpenNetworks Platform Works
A transparent loop for provider-defined programs, configurable custom networks, standard claims processing, and predictable payment.
Unique healthcare programs
Your rates. Your terms.
Providers set their rates and terms based on market demand.
Unique healthcare programs
Listed for custom networks.
Providers are available as an option for purchasers to include in custom networks they create based on their specific requirements.
Unique healthcare programs
Chosen on rates and terms.
Providers are selected for each custom network based on their rates and terms.
Unique healthcare programs
One card. Eligibility verified.
Employees access healthcare services using their OpenNetworks ID cards. Providers can easily verify eligibility.
Standard processing
Same workflow. Full visibility.
Providers submit claims using existing workflows and track the claim status throughout the adjudication process: processing steps, decisions, and appeals.
Standard processing
Edited and repriced, then passed along.
OpenNetworks performs claim editing and repricing and passes information along to purchaser or purchaser's TPA.
Standard processing
Adjudicated to contract terms.
Purchaser or TPA conducts final adjudication according to stated contract terms and submits form 835 to provider and OpenNetworks.
Predictable payment
Paid exactly as agreed.
Employer or TPA pays provider; employee pays cost-sharing balance.
Unique healthcare programs
Your rates. Your terms.
Providers set their rates and terms based on market demand.
Unique healthcare programs
Listed for custom networks.
Providers are available as an option for purchasers to include in custom networks they create based on their specific requirements.
Unique healthcare programs
Chosen on rates and terms.
Providers are selected for each custom network based on their rates and terms.
Unique healthcare programs
One card. Eligibility verified.
Employees access healthcare services using their OpenNetworks ID cards. Providers can easily verify eligibility.
Standard processing
Same workflow. Full visibility.
Providers submit claims using existing workflows and track the claim status throughout the adjudication process: processing steps, decisions, and appeals.
Standard processing
Edited and repriced, then passed along.
OpenNetworks performs claim editing and repricing and passes information along to purchaser or purchaser's TPA.
Standard processing
Adjudicated to contract terms.
Purchaser or TPA conducts final adjudication according to stated contract terms and submits form 835 to provider and OpenNetworks.
Predictable payment
Paid exactly as agreed.
Employer or TPA pays provider; employee pays cost-sharing balance.
The Provider Platform
How OpenNetworks is different
A simpler operating model for providers who want explicit terms, clearer administration, and a better path into new employer relationships.
Contract with usSet different rates tied to different business terms to meet market requirements.
- Providers decide on the programs, terms, and rates to offer through OpenNetworks.
- Providers present well-defined, consistent rules for payment, pre-authorization thresholds, audits, and related workflows.
- Purchasers select providers to participate in benefit plans based on available rates and terms.
Do you share our belief that healthcare needs more transparency and much less complexity? We're here to partner with you.
Contract with us