Provider Lifecycle Management

Why Provider Lifecycle Management
with V12 Network and V12 IPD?

Healthcare organizations that build and manage complex provider networks need real-time, accurate provider data and efficient and automated processes to meet regulatory requirements and to better engage with their providers. V12 Network, built on Salesforce Health Cloud, is a provider Provider Lifecycle Management solution that automates and streamlines the process of onboarding, credentialing, and contracting in a robust enterprise solutions. Unlike legacy application or custom software, V12 Network provides built in provider data checks and ongoing exclusion monitoring through our partnership and APIs to CAQH and ProviderTrust and helps health plans and health systems maintain and V12 IPD monitors changes in the provider’s data to alert you in real-time and help your organization update provider data real-time to ensure the most accurate and up to date provider directory data.


What is a Provider Lifecycle Management Solution?

A Provider Lifecycle Management solution helps health plans and health systems maintain and organize provider data real-time to ensure the most accurate and up to date provider directory data. In today’s world the use of cloud based platforms and AI provide automation and eliminate costly mistakes and manual effort. As provider networks become more complex with value based care models, specialty networks, virtual care and home care networks, it is more important than every to track and have access to all credentialing, contracting and payment term information on your providers real-time. Provider attestment is now an obsolete concept as it relates to meeting provider directory requirements. Monitoring provider data changes in real-time is the new normal.

The Importance of Accurate Provider Data with V12 IPD

Provider data is complex and is a core reason that we originally created the V12 IPD application as an AI engine that continually monitors provider data sources and alerts your organization to provider data changes. Provider data that is identified as changed and pushed into V12 Network as a provider data case that can be assigned and worked by your team or the system can be configured to automatically update the provider data and alert. It is all up to your organization’s unique workflow and how you configure the product.  

 

 At Virsys12, we believe that a robust provider data management solution paves the way for a truly integrated platform for connected workflow automation. Our V12 Network application continues to evolve to support the one-to-many and many-to-many relationships within the most complex provider hierarchy.

 

V12 IPD ranks data changes based on:

Data Age

Source System Truth

Completeness of Data

Data Derivation

Data Consensus

Detail Significance

With V12 Network It All Starts With Accurate Provider Data

Provider network data is complex and is a core reason that we originally created the V12 Network application on the Salesforce Health Cloud platform. At Virsys12, we believe that a robust provider network management solution paves the way for a truly integrated platform for connected workflow automation that uniquely creates value for our clients. Our V12 Network application supports the one-to-many and many-to-many relationships within the most complex healthcare payer and provider data models and supports the complex provider payment models and methodologies emerging today.

 

V12 Network Supports:

Complex Account Hierarchy and Payer/Provider Relationship Management

Market/Health Plan/Network Specific Segmentation and Configuration Capabilities

Provider Demographics Tracking and Interfaces, Hospital Affiliation, Practice Location, Physical and Billing Facility Site by Practitioner

Provider Credentials Including Board Certifications, Accreditations, Medical Licensure, Education, Insurance

Automated interfaces to CAQH ProView Data and ProviderTrust OIG Exclusion Data

Automated interfaces to USPS for address verification

Integration with Conga and Aptus Contract Management Systems

Complex Billing/Physical Tax ID & NPI Hierarchy Combination Management via the V12 Navigator Tool

Practitioner Tracking by Agreement Including Specialty, Taxonomy, Network, Par/Non-Par Effective Dates

Provider Panel Status Tracking and Monitoring

Network Contract Generation with Fee For Service and Value Based Care Participation Payment Methodologies

Mass Updates of Providers by Network, Tax Id, NPI, Practicing Location using the V12 Practitioner Manager Tool

Optional lnterface of Provider Data Activation and Updates to Claims Systems

 

At Virsys12, we have implemented V12 Network on an enterprise level and as a direct replacement for legacy provider data management solutions, excel spreadsheets, and access databases. Our experience has allowed us to work with both providers and payers to form a unique perspective on what a truly scalable provider data management solution entails. (download our e-book on provider data accuracy to learn more)

Save Time & Get Results You Can Prove

Virsys12 Salesforce consultants help you build your network using a scalable and powerful software platform, expand to new markets and add new networks with confidence and success. Get strong insights you can show and display to help promote your organization.

V12 Network can be implemented in record time. This Provider Network Management software displays integrated trends and comparative data for improved decision-making used to manage your network. It has secure; HIPAA-compliant access and reporting feature that make a positive impact on your organization and your team. 

V12 Network includes:​

Provider Outreach & Development

State agency, Employer, Member Entity Outreach and Development

Provider Onboarding, Credentialing and Fee Schedule/Payment Methodology setup

Electronic Network Contracting with stages (merging in payment terms)

Integration to CAQH, OIG, and State registries, and your claims system

Member Attributions List (with Health Cloud)

Member Engagement Campaign (with Marketing Cloud)

Integration with internal systems and Analytics (with Mulesoft and Einstein and Tableau)

Automate your Workflow

Imagine a world where provider specific workflows are in sync with a single provider source of truth, all on the same platform. Sound far-fetched? Not with the V12 Network and V12 IPD application! From initial provider outreach and network development, to credentialing and contract/fee schedule management, and integration into the claims system (including on-going data management) our applications ensures that your organization maintains a 360-degree view of both provider data and critical workflows as practitioners and provider groups join the network and continues their relationship with your organization to serve your members and patients.

The Power of the Salesforce Platform

We understand that provider network management and the associated workflows can be complex. Our V12 Network application offers both pre-built workflow automation, as well as, declarative Salesforce workflow automation capabilities using Salesforce Health Cloud. So, no matter what your workflow requirements are, we have you covered!

 

V12 Network Workflows Include:

Provider Outreach & Network Development

State Agency, Employer, Payer/Provider Outreach & Development

Provider Network Enrollment & Application Management

In-House, Delegated & CVO Based Credentialing Management

In-Patient/Out-Patient Fee Schedule & Value Based Care Payment Methodology Setup

Electronic Network Contracting with Stages & Payment Term Merge Capabilities

Member to PCP Attribution Tracking

Physician Liaison Management & Provider Network Maintenance

Advanced Provider Search Capabilities

Your Favorite Apps, All On A Single Platform

At Virsys12, we believe in the power of partnership. As such, our team has diligently worked over the last 10 years to evaluate and determine best-in-class third-party applications that compliment our solution set. The by-product of this work resulted in the creation of several pre-built integrations to some of the most popular third-party applications available. These pre-built integrations allow quicker time to value and reduce “swivel-chairing” between key third-party applications used throughout the provider lifecycle. 

Key Pre-Built Application Interfaces Include:

CAQH ProView

ProviderTrust Federal Exclusions Search (OIG-LEIE, SAM), State Exclusions Search (All, 42 currently available), NPI Active Status, Medicare Opt-Out, Preclusion List

ProviderTrust Primary Source Verification (State license boards, DEA Registration, Board Certifications, CLIA, NPDB)

USPS Address Database

NPPES (Available in the V12 Intelligent Provider Directory Application)

Conga Contract Lifecycle Management Application (CLM)

Google Location API (Provider Geolocation Capabilities)

Custom API-based integrations and ongoing data file transfers are also available in the V12 Network application through the Salesforce platform API. Common additional integrations include: EMRs/Practice Management Systems, Referral Management Systems, Claims/Adjudication Systems, Provider Directory Applications, Electronic Data Warehouses, etc. 

Transform Your Provider Network Management

With V12 Network, you will ...

Implement Results in as Quickly as 90 days

Lower Administrative Costs

Deprecate Existing Antiquated Technology

Increase Interdepartmental Collaboration

Increase Provider Directory Accuracy

Elevate Real-Time Analytic Reporting

Increase Provider Satisfaction

Your Customized Operational Platform for Provider Network Management

The world of healthcare is getting complex and disjointed. V12 Network is a seamless technology for managing complexity from operations to relationship management. Fostering deep collaboration between providers and payers. V12 Network is a comprehensive relationship & network management system that helps to organize and manage fragmented healthcare information and operations.

V12 Network is built on the Salesforce Health Cloud Platform.

Read V12 Network's Complete Guide

Ready to learn more about V12 Network? The breadth and functionality of V12 Network spans far beyond one page of information, but this quick, in-depth overview will help you start digging in.

Why Use V12 Network?

12%
Reduction in Time for Provider Directory Updates
70%
Improvement in Accuracy of Member & Physician Data
12%
Decrease of Overall Cost of Care in First Year
75%

Reduction in Time for Provider Directory Updates

99%

Reduction Time in Lead Set Up

46%

Reduction Time In Account Set Up

100%

Reduction Time in Multiple Location Entry

99

Day Saved Annually for Data Transfer

Who uses V12 Network:

Health Plans/Payers

Health Systems

Managed Care Organizations

Integrated Physician Networks

Accountable Care Organizations (MCOs, IPNs, ACOs)

Post-Acute Care Organizations (Senior Living Facility, Long-Term Care, Skilled Nursing Facility)

Third-Party Administrators (TPAs)

Learn More About Additional Use Cases
with Salesforce Products

See V12 Network in Action!

Whether you have a few quick questions, want a full demo of V12 Network or find yourself somewhere in between, we’re here to help.

Can’t wait? Call us at (615) 800-6768.

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