Specifications include, but are not limited to: • Supporting all provider types included in IEHP’s network, including but not limited to, primary care physicians, specialists, Medical Doctors, Doctors of Osteopathic Medicine, behavioral health providers (Licensed Clinical Social Workers, Marriage and Family Therapists, Psychologists, Behavioral Health Treatment/Qualified Autism Spectrum Providers), opticians, optometrists, ancillary vendors including transportation providers, laboratories, dialysis providers, home health providers, facilities (hospitals, skilled nursing facilities, residential care for the elderly), Independent Physician Associations, hospitalists, admitters, advanced practice practitioners, community health workers, doulas, community supports providers including but not limited to community based organizations. • Meeting the requirements of IEHP’s regulators and accreditations including Department of Health Care Services, Department of Managed Health Care, Centers for Medicaid and Medicare Services, National Committee for Quality Assurance. • All facets of provider contracting, from provider letter of intent receipt through execution. • All inherent aspects of provider credentialing, including, but not limited to, management of the entire application process, automated verification of provider licensures, education, sanctions, etc. • All provider data maintenance and management. • Ability to connect to other platforms utilized by the plan including, but not limited to, IEHP’s provider portal, medical management, and claims systems. • Workflows and communication of provider information, both internal and external facing. • Data analytics and reporting for multiple purposes, including but not limited to, provider network development, value-based contracting, regulatory reporting and compliance with all credentialing requirements, management and alignment of contracts.
