LA CARE

LA Care Health is the nation’s largest public health insurance entity with close to $10B annual spend taking care of 2M members with 10K providers. Apart from the timely and accurate provider network adequacy reporting to regulatory bodies and healthcare agencies there was a strong need to validate provider credentials/facilities and support accurate member assignments.

THE CHALLENGE

Poor quality provider data lead to high operational costs and poor standards of service that was delivered to members. Being in the healthcare delivery space, this could not only cost the company financially but also damage their reputation and credibility.

• Ensure members are able to receive care from various hospitals, practitioners and ancillary provider types based on regulatory parameters through complete visibility of the provider network and their associations.
• Submit provider network adequacy and other provider-related data to regulatory and accreditation agencies to ensure LAC is compliant. Certify providers (18+ certifications) with a streamlined credentialing workflow.
• Conduct manually intensive facility site reviews for various provider facilities on different periodic schedules with active tracking of review assignment, corrective action plans (CAP), scores and status.