The OpenNetworks platform
The infrastructure for
transparent healthcare contracting.
Direct contracts, network design, provider data, and claims repricing — connected from the first agreement to a predictable payment workflow.
Explore your network↗Provider-defined programs
Providers establish rates, services, and business terms.
→Configurable networks
Purchasers curate relationships around their members.
→Claims + repricing
Claims are repriced against the agreed contract terms.
→Predictable payment
The employer or TPA finalizes the claim and pays the provider.
01 / Direct contracting
Agree on the terms.
Build from there.
Provider-defined programs make the services, rates, and business rules explicit. Purchasers can assemble those relationships into a network that reflects their own workforce and strategy.
Portals and APIs connect the contract to the people and systems that need it. The network becomes something you design, not something you buy pre-packaged.
02 / Rate transparency
The same rate.
On both sides.
Purchasers see what they pay. Providers see what they earn. Clear rates and business terms provide a shared starting point before care is delivered.
Current provider data, validated across multiple sources, helps the network stay useful as relationships change.
03 / Claims + repricing
Connect the contract
to the claim.
The claims engine and internal repricer apply the contracted terms and return the priced claim to the employer or TPA. That administrator finalizes the claim and processes payment.
Use your own claims data to evaluate the network and discuss an independently validated repricing analysis with the team.
Network design / Before you launch
Start with your people.
Then shape the network.
Provider network management means selecting, contracting with, and reviewing the providers that serve your population.
- 01
Map the need
Start with where members live, the services they use, and the provider relationships they want to preserve.
- 02
Review the terms
Compare participating provider programs, contracted rates, and business terms against those needs.
- 03
Model the fit
Work with the team to model coverage, contracted rates, and expected spend against the current plan.
- 04
Review as needs change
Revisit network composition with your administrator as your workforce and care needs evolve.
The operational detail
Follow the claim.
Know who does what.
Claims repricing applies the agreed contract rate to a submitted claim. Final adjudication and payment remain with the employer or TPA.
- 01 / Provider
Submits the claim
After the member receives care, the claim travels through the clearinghouse for delivery to OpenNetworks.
- 02 / OpenNetworks
Applies contracted terms
The platform reprices the claim and routes the priced claim to the employer or TPA.
- 03 / Employer or TPA
Finalizes and pays
The administrator completes adjudication under the plan and processes payment to the provider.
Employer enrollment comes before care. Member cost-sharing follows the benefit plan.
Aligned economics
A platform fee.
No hidden incentives.
Per employee, per month. No hidden fees. No percentage-of-savings take.
Discuss pricing and scope ↗Connected by design
Everything connects.
Everyone sees clearly.
Contract directly
Build a provider network with no carrier intermediary. Purchasers and providers agree to rates and terms.
Make every rate transparent
See what you pay and what providers earn. Contracted rates are explicit on both sides.
Process and reprice claims
Connect claims to contracted terms, with repricing returned to the employer or TPA for finalization and payment.
Build on transparent infrastructure
Portals, APIs, and a claims engine connect the work from network design through repricing.
Trust current provider data
Work with provider data validated across multiple sources, with a shared view of network relationships.
Serve the whole network
Bring self-funded employers, TPAs, brokers, and providers into one connected workflow.
The future is open