For health plans
A network model with one point of contact.
Marton Care IPA works with Medicaid managed care organizations and workers’ compensation PPOs in New York. The IPA brings independent providers of several types into one network relationship, while each provider keeps billing the plan directly.
Network and oversight
Provider types
Diagnostic and treatment centers, mental health and substance use disorder providers, licensed and certified home care agencies, social adult day care centers, and ambulance and EMS agencies.
Credentialing and monitoring
Organization approval and practitioner credentialing are separate decisions, each recorded with its evidence. Review against exclusion and sanction sources is part of the model, and findings are reviewed before any action.
Participation and directory
Participation is recorded per product, service, location and effective period. Only verified participation produces a directory badge or a match in a plan-filtered search; IPA approval alone never implies participation.
Contracting and participation
Discuss scope
Which products, services and provider types the plan wants to cover through the IPA.
Identify the contract option and approvals
Negotiated rates proposed by the provider and accepted by the plan, or plan-rate acceptance by reference to the applicable identified schedule and version, with the approvals each requires.
Confirm participation
For each product, service, location and effective period. Providers bill the plan directly.
Proposed rates take effect only once the plan accepts them. One network relationship does not remove the approvals each provider still needs.
Evidence, rosters and data
Credentialing evidence
The IPA keeps the evidence behind each decision. The model provides for sharing the relevant verification evidence with authorized recipients under the applicable agreements.
Rosters
Participation records are the source of any roster the plan receives, so a roster line exists only for verified participation.
Information handling
We handle protected health information only for authorized purposes under the agreements and privacy requirements that apply to each relationship.
Value-based payment
Marton Care IPA is working to secure health-plan contracts using a value-based payment (VBP) model that includes shared savings.
Talk with us
Tell us which products and provider types you have in mind and we will take it from there.