Provider Network

An essential part of any healthcare delivery system is the Provider Network. Onicol can utilize its own network, manage the network that is assigned or a combination of both. Onicol develops specialty and PPO networks one of two ways; (1) actively recruiting Providers within specialty networks or (2) customers will assign provider agreements to Onicol and Onicol will manage the network.

  • For each MCO contract and for each specialty Onicol will maintain a network of participating specialty providers
  • Under capitation participating providers will be contracted and reimbursed directly by Onicol
  • Our contracts will be in lock step with the MAB's Protocols and Pathways and the Payors Benefit Design so that reimbursement is tied to performance and outcomes

Onicol Network Standards for both preferred provider organizations (PPOs) and specialty networks will encourage open-panel networks to become more integrated in day to day operations with a strong emphasis on quality assurance and improvement. Onicol has at least one community provider sit on the Company's UM Committee and Credentialing Committee. The Health Network Standards are comprised of three areas: network management, credentialing and consumer protection.

Networks and services may vary depending on the type of health care services being offered, the geographic area and populations served. The Company will establish goals and measure performance as it relates to access to care, availability of providers, provider selection criteria and performance. And our Provider Agreements seek to ensure member access to covered services that may not be available through participating providers and emergency care, both in and out of the network.

Provider Network

Onicol maintains a strategy for incorporating the perspectives of participating providers either through the Prior Authorization Process or through participation on the Company's UM Committee or Credentialing Committee. Dedicated staff will provide support, training and conflict resolution. We believe that effective training has a tremendous impact on initial launch of new Programs and reduces error rates, frustration and costs. Therefore, we implement rigorous training criteria with our Providers and their staff on Benefits and Eligibility, Prior Authorization and Claims Management prior to the effective date of operations.

Provider Credentialing

Onicol develops and implements a credentialing plan that is approved by the Company's executive management. That plan addresses the full scope of the credentialing including the types of providers to be credentialed as well as program governance and oversight. This includes the formation of a credentialing committee, and a policy that assigns a senior clinical staff person to all clinical aspects of the credentialing and provider selection criteria.