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Provider Performance

What could your plan achieve with a greater ratio of high-performing providers in your network? SKYGEN helps payers partner with high-performing providers and improve member satisfaction. Our provider performance service uses a rating methodology that helps determine which providers are the best stewards of the programs you administer. Our provider performance ratings are designed to measure the appropriateness and efficiency of care delivered by each provider, enabling payers to reward high-performing providers with increased referrals or higher reimbursements, while reducing and preventing fraud, waste, and abuse.

Provider Performance

SKYGEN’s Provider Performance examines:

  • Electronic adoption – Claims, authorizations, direct deposit
  • Code Ratios – Preventive to restorative services, restorations to sealants, surgical to simple extractions
  • Frequencies – Services per visit, radiographs per patient, extractions per member
  • Claims submission accuracy
  • Track record on authorizations
  • Fraud, waste and abuse (FWA)
  • Member complaints

Better Outcomes For Members

Increased Satisfaction For Providers

Reduced Cost of Fraud, Waste, and Abuse

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