Network Management

ReliaCare staff follows an established process to credential providers for our networks. Providers are initially credentialed prior to network admission and re-credentialed every three years. ReliaCare conducts verification of the practitioners as defined by its policies, state and federal regulations and in accordance with accrediting standards. The initial credentialing process includes:

Network Management
  • Completion of an application
  • Primary source verification
  • Inquiry to National Practitioner Data Bank for sanction history
  • Other verification as needed
  • In depth review of site by site capabilities to insure proper depth of coverage for all DME and O&P products and services
The re-credentialing process includes the same components as initial credentialing with the exception of an onsite review, that is conducted during the initial process and/or as needed. At the time of re-credentialing a review of quality information which includes, when available, member satisfaction, member complaints related to both administrative and quality of care issues, malpractice history, medical record reviews, office site review information, and information regarding clinical quality actions or sanction activity will be considered for continued network participation.

Availability of network practitioners

Network evaluations are performed annually on the number and geographic distribution of the provider network in relationship to the location of its members. In addition, ReliaCare takes into consideration the special and cultural needs of members in maintaining its network of providers.

Accessibility

ReliaCare monitors the ability for member access to services for routine, urgent, emergency and after-hour care. The standards of care are as follows:
  • Immediate service for emergency or life threatening illness or injury
  • Urban coverage within 30 miles/15 minutes of member residence
  • Suburban coverage within 60 miles/30 minutes of member residence
  • Rural coverage within 1 hour of member residence
To find out how ReliaCare’s Network management products can help your plan lower its costs and increase member satisfaction click here.



  • Credentialing & Contracting
  • Price Setting
  • Benchmarking & Reporting
  • Access Guarantees
  • Follow payer and regulatory guidelines
  • Follow benefit design
  • Physician Outreach
  • Patient/Family Coordination
  • Delivery Confirmation
  • Regulatory guidelines followed
  • Electronic submission increased
  • Reporting to support benchmarking
  • All languages supported
  • Multi-tiered Operational Reporting
  • Extensive Data Aggregation