Solutions

Network Management

Clinical Review

SecureCare’s Clinical Review program is designed to help ensure in-network clinics are delivering an appropriate level of care based on medical necessity, while allowing providers to practice without unnecessary administrative barriers. Rather than relying on prior authorization to determine the appropriateness of care, we provide ongoing oversight through retrospective claims analysis and a comprehensive, data-driven review. This approach allows us to identify utilization patterns while minimizing disruption to providers who consistently demonstrate appropriate practice patterns.

Historical claims data, combined with SecureCare’s understanding of typical practice patterns by profession, is used to establish appropriate review thresholds. When a clinic exceeds a defined threshold, an in-depth medical record review is initiated by licensed clinical peers to determine whether the care provided is medically necessary and consistent with the health plan’s medical policy, using established Best Practice Standards as a supporting framework.

Clinics that remain below the review threshold can continue to practice with minimal oversight. To promote transparency and continuous improvement, monthly report cards and trending reports are made available through the Provider Portal, providing key performance metrics for each clinic along with comparisons to peers across the network. This data-driven approach gives providers meaningful insight into their performance while helping health plans maintain appropriate oversight of conservative care utilization.

Credentialing

Credentialing is a critical function that allows SecureCare to identify, verify, and select qualified providers to participate in our network. Our comprehensive process helps ensure providers meet established industry standards and applicable requirements while supporting the overall quality and integrity of the network. Since achieving URAC accreditation in 2012, we have credentialed thousands of conservative care providers, giving us the experience and expertise to efficiently manage the process while maintaining a strong focus on accuracy, compliance, and quality.

Credentialing Verification Organization (CVO)

Since 2018, SecureCare has operated as a URAC-accredited and NCQA-compliant CVO, providing credentialing and verification services across all provider types. Our experienced team delivers a streamlined, efficient process designed to reduce administrative burden and provide clients with confidence in the providers within their networks. With the ability to manage credentialing across a broad range of specialties and provider types, our CVO services offer a scalable solution for organizations seeking to strengthen network oversight while maintaining verification and compliance standards.

Network Performance Analysis

Upon a payer’s request, SecureCare can generate a comprehensive “Opportunity Analysis” designed to identify opportunities for improved conservative care network management, greater efficiency, and potential cost savings, while also highlighting areas of strength and positive performance across the network. Our team performs an in-depth review of historical claims data to identify utilization patterns, cost drivers, areas of opportunity, successful practices, and potential areas of concern. The analysis provides a specific, data-driven assessment tailored to the payer’s population, helping to identify where targeted network management strategies may have the greatest impact while also recognizing and reinforcing the areas where the network is performing well.

Our goal is to turn claims data into actionable insights. By highlighting specific opportunities and providing a clear view of the potential impact, our Opportunity Analysis gives payers a practical starting point for evaluating network strategies and opportunities for improvement. Learn more about our Opportunity Analysis and how it can help identify opportunities within your conservative care spend.

Provider Education

SecureCare is committed to ongoing provider education as a means of improving the quality and consistency of care delivered through conservative care. Through multiple avenues of education, resources, and engagement, we assist our providers with the knowledge and tools they need to support positive outcomes while delivering appropriate, medically necessary care. Our education efforts are designed to keep providers informed of best practices, evolving clinical standards, and opportunities to strengthen patient care. By investing in our provider relationships and fostering a collaborative partnership, we help create a stronger network focused on quality, appropriate care, and better outcomes.