Network access, repricing and back office in one place.
TPAs, carriers, employers and health systems use Evolutions for direct provider access and for the operational work behind it. Now with OpenNetworks technology and infrastructure supporting delivery.
Choose the network, or the whole operation
Take network access alone, or hand us the back office behind it. Most clients start with one and add the other.
Claims repricing
A flexible engine that interprets, calculates and reprices against complex matching protocols and network tiering, with EDI in and out.
Employer-specific directories
Directories built per group, identifying tiers and benefit differences upfront so members land on the right provider.
Contract management
Contract delivery and tracking, credentialing, demographic data collection, provider outreach and education.
Total back office
Full-service support for regional or hospital-based networks, from contracting through repricing and customer service.
From first call to first repriced claim
Define the network
Geography, specialty mix, tiering and the plan design the network has to support.
Disruption and access analysis
We model your census against contracted providers so you know what coverage looks like before you sell it.
Connect the data
Eligibility, claims and directory feeds are configured to your formats, with portal access for your team.
Go live with support
Member and provider service lines, reporting and a named account contact from day one.
Modern portals, APIs and transparent rates
OpenNetworks brings the technology layer: API access to network and rate data, modern portal experiences for your team, and a repricing platform built for direct contracting.
Learn about OpenNetworks →Already a client?
The Payor Portal is where you pull directories, submit claims for repricing and check status.
Sign in to the Payor Portal →Let's build the network your plan needs.
Talk to the Evolutions network team about a customized network.
