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Stakeholder Collaboration
Home / Unified Payer Platform / Stakeholder Collaboration

Engage Partners that Predicate Your Success

The complexities involved with making the transformation to value-based healthcare while remaining compliant and improving business performance are immense. Health plans, PBMs, integrated delivery systems, specialty pharmacies and managed services organizations cannot do it alone. Their success is predicated by many stakeholders who play a critical part in each of these processes. Healthcare organizations need to engage critical stakeholders such as providers and service providers as they have a direct impact on compliance, operational performance and revenue realization.

MedHOK’s Unified Payer Platform provides full-function stakeholder collaboration through proactive features, such as our Provider Portal, 360Provider Dashboard, Provider Disputes and Partner Delegation Oversight. In addition, MedHOK's Unified Payer Platform is pre-integrated with a range of critical industry data and decision support sources including clinical criteria, health education, risk adjustment, quality management, information exchange, pharmacy files and PBMs.  MedHOK's Unified Payer Platform provides everything you need to succeed in value-based healthcare and compliance. It's all right here. 

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Provider Portal Collaboration

Engage critical stakeholders including providers to improve member service, increase quality, and drive revenue realization

Partner Delegation Oversight

Ensure partners are providing compliant support to ensure adherence to CMS guidance

EXPANSIVE INTEGRATION PARTNERS

Pre-integration with leading providers of clinical data and decision support tools

Stakeholder Collaboration Components

MedHOK enables healthcare organizations to engage critical stakeholders to improve business relationships, drive better member care and improve compliance adherence.

Learn more about the Stakeholder Collaboration components in MedHOK's Unified Payer Platform by clicking the titles below.

MedHOK’s Provider Portal enables proactive and supportive collaboration with your network of providers. The Provider Portal provides real-time and actionable information to providers for each assigned member, boosting compliance, quality of outcomes and revenue. MedHOK’s Provider Portal goes beyond facilitating just administrative activities by enabling important care, quality and compliance activities. With MedHOK’s Provider Portal, payers can facilitate all care in a timely fashion.

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360Provider is part of the enterprise-wide functionalities of the MedHOK Unified Payer Platform. 360Provider aggregates all demographic information on the provider as well as data related to all members assigned to a given provider or treated by one. All associates working in the system have access to the most complete, accurate, and real-time data on a provider to improve care, quality, and member satisfaction.

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MedHOK’s Provider Disputes feature is a pre-configured workflow solution for processing and tracking provider disputes from a member and/or provider. The system-defined workflow ensures that cases are processed consistently, and correspondence is triggered automatically and is attached to the case. Along with Root Cause Analysis and Process Improvement functionalities, health plans resolve appeals in a timely manner and drive operational improvements. The Dashboard allows for real-time monitoring of activity by management and promotes a proactive approach to caseload and compliance deadlines.

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MedHOK is partnered and fully integrated to critical industry data sources across the medical and pharmacy spectrum of care:

  • MCGMcKesson InterQual and Integrated Coordinated Care Content iare integrated to support clinical decision-making. Users can access the content from within the MedHOK Unified Payer Platform and the clinical summary report is automatically added to the case.
  • MedHOK is also partnered, and fully integrated, with Medi-Span and First Data Bank to facilitate drug selection for prior authorizations and real-time claim effectuation
  • MedHOK is fully integrated with CONNECT software, which uses Nationwide Health Information Network (NHIN) standards to ensure compatibility with other exchanges
  • MedHOK can accept custom, client-specific guidelines

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White Paper

Focus on the Member: The Premise for Value-Based Healthcare

Value-based healthcare requires a focus on the member - quite a shift from the provider-centric, transaction-focused models with which payers are familiar. This paper discusses how a focus on the member will result in better quality, care, and outcomes.

Fill out the form to the right to download the paper now.