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What We Do

    Services include...

  • Credentialing, all clinical providers – NCQA Certified in Credentialing
  • • Western Providers is delegated for provider credentialing for all clients (payers) – providers submit one credentialing application and Western Providers Credentialing Committee approval satisfies the credentialing requirements for all clients/payers
  • • Monthly, on-going quality measures, reports and statistical analyses are used to monitor the quality of the entire Western Providers panel
  • Network Development, on a payer specific basis for
  • • ERISA self-insured health plans
  • • Insured health plans
  • • Preferred Provider Organizations (PPO's)
  • • Governmental plans (Tricare and VA)
  • • Web site: Payer specific provider networks
  • Pricing
  • • Messenger model (fee-for-service)
  • • Shared Savings model
  • • Primary Care Capitation model
  • Compensation Models
  • • Discounted fee for service
  • • Relative Value Scale
  • • Inpatient DRG's
  • • Shared Savings
  • • Primary care risk model
  • Provider Education
  • • Western Providers provides email alerts and updates from specific clients/payers as Western Providers is notified of client/payer process changes
  • Credentialing
  • • Credentialing is conducted with the assistance of an independent credential verification organization that performs primary source documentation. Providers must undergo review and approval by the Western Providers Credentialing Committee. The credentialing/re-credentialing process is conducted in a non-discriminatory manner; credentialing decisions are not made on the basis of an applicant’s race, ethnic/national identity, gender, age, sexual orientation, or the type of procedure or patient (e.g., Medicaid) in which the practitioner specializes, but solely on the criteria referenced by this policy and associated procedures. Western Providers reserves the right to limit participation in the WPPO panel to specialties and number of practitioners needed to ensure an appropriate panel and to limit to practitioners willing to adhere to WPPO requirements.
  • Cost Management
  • • Messenger Model - For employer self-funded health plans, the provider network is developed through a legally qualified “messenger model”, an independent pricing process designed to obtain competitive provider costs.
  • • Risk-based products - For some health plans, both employer self-funded and insured, a Western Providers panel is developed using capitation or other financing approaches that provide incentives for physicians and hospitals to manage costs
  • • Population Health Management