Provider Network Management

Envolve uses a modular platform for contracting, service inquiry, documentation, and data management to effectively and efficiently manage provider networks. We offer providers a value-based reimbursement model centered on aligning quality measures, HEDIS measures and HH incentives to reward high-quality care. These provider network management offerings help reduce waste, slow the growth of healthcare costs, and improve the health of individuals.

Envolve’s provider network management solutions offers analytics tools and near real-time transactional data to help providers become aware of their status and outcomes of their patients through timely reporting.

Envolve’s Provider Portal provides access to:

Patients' care plans
Authorizations
Medical and pharmacy claims utilization data
Lab test results

The Envolve Provider Portal supports our providers in their practice of evidence-based medicine. Our provider network has access to actionable information, dashboards and a number of administrative self-service capabilities and clinical applications. Self-service capabilities of our provider portal include:

Secure messaging
Eligibility inquiry
Authorization submission
Online claim submission and claim status inquiry
Referral options patients for care and disease management
Clinical capabilities include:
- Care Gap Notifications (Direct Care Alerts)
- Patient Panel including disease registry
- Patient Health Record
- Patient Care Plan
- Practice-level clinical quality and cost reports
- Clinical practice guidelines
- Practice Improvement Resource Center, a searchable compendium of information on evidence-based toolkits and best practices, practice guidelines, multi-media content, and interactive tools to help providers manage the clinical, operational, and technology aspects of their practices

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