Provider Portal

Better information, better outcomes

Real world tools for real world issues

Ensuring access to the needed information and tools for your provider community can be a challenge. Appropriate access alone is complex, given that most provider users aren’t necessarily the clinicians that are captured in your core systems.

A robust security model that ensure access to the right tools and the right patient info is at the core of our provider portal solution, topped with an impressive stack of features supporting everything from eligibility requests to pay for performance incentives.

“The reduced manual review of authorization requests has enabled us to completely reallocate 2 FTEs.”

Streamline authorizations for you and your providers

With real-time response and an advanced rules engine (including medical policies), our online Referrals and Authorizations submission capability is changing how plans approach this complex topic. Improve up-front information gathering from providers and reduce manual workflows for the plan.

Make it easy to identify and close gaps in care

Our interactive Provider Scorecard drives improvements in care quality, cost and value-based payment transformation. Leverage role-based security to manage access at the medical group, clinic and individual provider level. View overall performance or drill into the detailed measures, analyzing historical trends, peer benchmarking and performance compared to targets at each level.

Seamlessly tie measures to the portal transactions – claim or authorization submission, assessment forms, documentation uploads, and more – making it easy to work through the gaps rather than just view them.

Share care plans across the care team

With the Shared Care Plans feature, providers can collaborate on the member’s care plans developed by the care management team inside the health plan. A shared view of each care plan and the associated issues, goals and interventions supports plan adherence and care team communication.

More time online and less on the line

Whether you’re looking for a full complement of provider tools or you have multiple existing tools you’re looking to draw together, the Smart Series platform offers a centralized location for providers to access everything they need to work with you.

Provide one location for your providers to access:

  • Eligibility and benefit information
  • Claims and authorization status
  • Real-time authorization requests
  • Care management plan details
  • Quality care and cost performance
  • Care gap closure tools
  • Patient history and care alerts
  • Plan policies and forms

Smarter Solutions

Learn more about the various tools supporting self-service, care coordination and pay for performance for your provider.

Smart Connect

Self-serve tools allow members, providers, employers and brokers to manage their everyday activities

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Smart Record

A shared, interactive health record driving transparency and collaboration across the member’s entire care team

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Smart Metrix

Action-oriented scorecards driving improvements in care quality, cost and value-based payment transformation

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