Managed Care Organizations (HMO & DMO)
We work on both sides of the contracting table. For health and dental maintenance organizations, that means network development, provider contracting administration, credentialing operations and network adequacy support — informed by having run these functions from inside a plan.
What regulates you
- Texas Department of Insurance requirements for health and dental maintenance organizations, including network adequacy obligations
- Credentialing and re-credentialing standards
- Provider contracting and directory accuracy requirements
- State and federal requirements applicable to your product lines
What we do for you
- Network development and provider recruitment strategy
- Provider contract template development and contract administration
- Credentialing operations design and delegated credentialing oversight
- Network adequacy analysis and gap remediation planning
- Fee schedule design and provider reimbursement modelling
- Provider relations process design and dispute resolution structures
Frequently asked questions
Why would a provider-side consultancy work with plans?
Because our founder built and ran these functions inside plans before advising providers, and because network adequacy and contracting problems look different — and get solved faster — when you can see both sides. We disclose and manage conflicts before engaging.
Can you support delegated credentialing oversight?
Yes, including the audit structures a plan needs to demonstrate oversight of a delegated entity.
Do you support dental plans specifically?
Yes. DMO network and contracting work is within scope.
Related services
Talk to someone who works with your provider type every week
Describe where you are — opening, cited, stalled, or renegotiating — and we will tell you what the path looks like.