Services
Insurance Advisory & Connections
Insurance relationships directly affect patient access, revenue and the commercial performance of healthcare facilities. NGHCS helps healthcare organizations understand their insurance requirements, evaluate opportunities and connect with relevant insurance and healthcare network stakeholders.
Challenge
Insurance participation can significantly influence the growth and financial performance of a healthcare facility.
Navigating insurers, networks, requirements and commercial arrangements can be complex and time-consuming.
For hospitals, clinics, medical centers, pharmacies and other healthcare providers, insurance relationships can affect patient volumes, reimbursement processes, revenue-cycle operations and access to different patient populations.
However, identifying appropriate insurance opportunities, understanding requirements and coordinating discussions with relevant stakeholders often requires significant management time and healthcare market knowledge.
NGHCS helps healthcare organizations assess their insurance requirements, prepare for relevant discussions and facilitate connections with appropriate insurers, TPAs and other industry stakeholders where suitable.
Insurance Advisory & Connections
Healthcare insurance support focused on stronger relationships, informed decisions and sustainable business opportunities.
Insurance Network Advisory
We help healthcare facilities understand their insurance network requirements and identify areas where additional payer relationships may support their patient-access and business objectives.
Insurer & TPA Connections
Based on organizational requirements and relevant opportunities, NGHCS can facilitate introductions and communication with appropriate insurance companies, third-party administrators (TPAs) and other healthcare insurance stakeholders.
Network Application Support
We help healthcare organizations understand and organize requirements associated with insurance network applications and support coordination throughout the relevant process.
Insurance Readiness Assessment
Before approaching insurance networks, healthcare facilities need appropriate operational, administrative and documentation readiness. We help assess relevant requirements and identify areas that may need attention before proceeding.
Commercial & Contract Considerations
Insurance relationships can involve tariffs, contractual terms, payment arrangements and other commercial considerations. We help organizations evaluate the business implications and coordinate appropriate specialist support where required.
Tariff & Service Review
We help healthcare organizations review their services, pricing considerations and relevant commercial information when preparing for discussions with insurance stakeholders.
Insurance Process & Workflow Advisory
Successful insurance participation requires effective internal processes. We help organizations review workflows related to eligibility, approvals, billing, claims and other insurance-related administrative activities.
Ongoing Insurance Relationship Support
Insurance requirements and business relationships can evolve over time. NGHCS can support healthcare organizations with ongoing coordination, relationship management and identification of relevant insurance opportunities.
From insurance requirements
to
stronger healthcare connections.
Process
01 —
Understand
Insurance Requirements Assessment
We begin by understanding your healthcare facility, specialties, services, current insurance relationships, patient profile, operational capabilities and business objectives.
The objective is to establish what type of insurance support or network opportunities are relevant to your organization.
02 —
Evaluate
Readiness & Opportunity Assessment
We assess relevant operational, documentation and commercial considerations and review potential gaps that may affect insurance discussions or network applications.
Where appropriate, we also help identify insurance relationships that may align with the facility’s services and business objectives.
03 —
Select
Insurance & Network Opportunities
Based on the assessment, we help prioritize relevant insurers, TPAs or network opportunities.
The objective is to focus management effort on relationships that are appropriate for the organization’s services, market position and operational capabilities.
04 —
Connect
Introductions & Application Coordination
Where suitable opportunities exist, NGHCS can facilitate relevant introductions and help coordinate communication, documentation and application-related activities between the healthcare organization and insurance stakeholders.
05 —
Support
Commercial & Operational Coordination
As discussions progress, we help the organization understand relevant operational and commercial considerations and coordinate required actions with internal teams and external stakeholders.
Where specialist legal, financial or other professional advice is required, appropriate expertise can be coordinated separately.
06 —
Optimize
Ongoing Insurance Relationship Support
Insurance participation does not end when a relationship is established.
NGHCS can continue supporting healthcare organizations by reviewing insurance-related operational challenges, identifying additional opportunities and helping strengthen coordination with relevant stakeholders.
Healthcare IT advisory for organizations
across the healthcare ecosystem
Who We Support
Hospital
Medical Center
General and specialty clinics
Dental clinics
Laboratories
Pharmacies
Home healthcare providers
Healthcare startups
Build the Right Healthcare Insurance Relationships With Confidence
Whether you are seeking your first insurance network relationship, expanding your existing payer portfolio or improving the way your facility manages insurance-related operations, NGHCS can help you assess the requirements, identify relevant opportunities and coordinate the process.
Frequently
Asked
Questions
What does NGHCS Insurance Advisory & Connections include?
NGHCS helps healthcare organizations assess insurance requirements, evaluate readiness, identify relevant network opportunities and coordinate connections and discussions with insurers, TPAs and other appropriate healthcare insurance stakeholders.
Can NGHCS help our healthcare facility join insurance networks?
We can help assess your requirements, support preparation for network applications and facilitate relevant connections where appropriate. Acceptance into an insurance network remains subject to the insurer or TPA’s own criteria, commercial requirements and approval process.
Can you connect us directly with insurance companies or TPAs?
Where NGHCS has an appropriate relationship or identifies a suitable opportunity, we can facilitate introductions and help coordinate communication. A connection does not guarantee empanelment, contracting or acceptance by an insurer or TPA.
Can you help us prepare for an insurance network application?
Yes. We can help identify relevant requirements, organize the process and assess operational or documentation areas that may need attention before or during an application.
Does NGHCS negotiate insurance contracts on our behalf?
NGHCS can support commercial discussions and help healthcare organizations evaluate relevant business considerations. Where formal legal, contractual or regulated professional advice is required, we can coordinate with appropriately qualified specialists.
Can NGHCS help existing facilities improve their insurance operations?
Yes. We can review insurance-related administrative workflows and identify areas for improvement involving eligibility, approvals, billing, claims and other relevant processes. More detailed revenue-cycle improvement can also be addressed through our RCM Audit & Optimization service.