Your programs
Define the services, rates, and participation terms you want purchasers to evaluate. Hospitals, physicians, outpatient services, and ancillary providers can bring different programs to the platform.
For providers
Reach new markets.
And new members. On your terms.
OpenNetworks is not another health plan and not a narrow network. It gives providers control over programs, rates, and terms — and a direct connection to healthcare purchasers.
Contract with us↗Your programs. Your terms.
Care is your work.
Control should be yours.
Build direct-to-employer relationships around the care you deliver. Tie provider-controlled rates to clear business terms, so the agreement is visible to everyone who relies on it.
Let’s talk about your programs ↗From your terms
to a direct relationship.
Eight steps. One shared workflow. Clear responsibilities for every participant.
- 01
Set your terms
Define rates and programs based on your services, market demand, and business priorities.
- 02
Publish your programs
Make rates, covered services, and participation terms visible on the platform.
- 03
Connect with purchasers
Employers, brokers, and TPAs evaluate programs against their workforce needs.
- 04
Agree to the relationship
Purchasers curate networks from published terms and establish direct contracts.
- 05
Make the rules explicit
Align on payment, prior authorization, audits, and operational responsibilities.
- 06
Deliver care
Members access the providers and services selected for their benefit plan.
- 07
Reprice the claim
OpenNetworks applies the contracted rates and returns the priced claim through the workflow.
- 08
Receive payment
The employer or TPA finalizes and pays the claim. The employee pays applicable cost-sharing.
Clarity in the contract
Fewer assumptions.
More explicit terms.
Rates + business terms
Provider-controlled rates tied to the relationship and the services offered.
Payment + authorization
Clearly defined operational rules, including payment and prior authorization.
Audits + accountability
Visible agreements that support a shared understanding of contract performance.
For billing and operations teams
Make the handoffs
part of the plan.
A direct contract needs clear operational responsibilities as well as a clear rate. Bring your billing team into the conversation early.
The claims route
Review clearinghouse routing and eligibility workflows with OpenNetworks and the administrator. Claims reach OpenNetworks for repricing before returning to the employer or TPA.
The payment responsibility
Align on authorization rules, audit terms, and payment responsibilities in the agreement. The employer or TPA finalizes and pays the claim.
The future is open