Health Plans
Health Plans have a responsibility. Build that trust with your members by following what we have in place for you. Deliver exceptional member experiences while meeting regulatory requirements
Simplify Compliance, Boost Directory Accuracy, and Protect Revenue
Take control of your provider data with ProviderLenz™—the ultimate PDM platform built to eliminate “ghost networks,” streamline roster ingestion, and meet strict federal and state mandates.
Who we serve in the Health Plan Market:
Medicare Advantage Plans:
Ensure strict compliance with the REAL Health Providers Act, including mandatory 90-day verification cycles, real-time signal monitoring, and public accuracy readiness.
Medicaid Managed Care Organizations (MCOs):
Maintain robust, up-to-date provider networks across highly dynamic, low-income, and transient provider panels.
ACA Exchange & Commercial Health Plans:
Drive member satisfaction and reduce cost-sharing disputes by eliminating out-of-date and inaccurate directory data.
Specialty Health Plans (Dental, Vision, and Behavioral Health):
Manage unique provider taxonomies and multi-location networks with precision.
Why
Why ProviderLenz™ is Built for Health Plans
For health plans, bad provider data isn’t just an administrative headache—it’s a major compliance and financial risk. Inefficient, manual claim reviews, costly appeals, and the threat of regulatory penalties demand a modern approach.
ProviderLenz™ transforms how health plans manage, disseminate, and access critical provider data:
- Automated Roster Management: Ingest, clean, and reconcile complex partner and delegation rosters in hours instead of weeks, eliminating manual data entry and human error.
- Continuous Directory Curation: Credentialing tells you if a provider can practice; ProviderLenz™ tells you if they are practicing, where they are, and if they are accepting new patients.
- Turnkey Compliance & Auditability: Out-of-the-box support for the REAL Health Providers Act and CMS mandates, giving you fully auditable data lineage for every directory record.
