Organization Types & Relationships
eKlotho Nexus supports 8 healthcare organization types with distinct vertical (hierarchical) and horizontal (collaborative) relationship structures. Each organization type has unique module requirements, regulatory obligations, and integration needs.
Hierarchical Structure (Financial Flow)
Administrative service layer: TPAs (payer side) and MSOs (provider side) operate across all levels
Cross-Organization Relationships
| Entity A | Entity B | Relationship | Nature |
|---|---|---|---|
| Health Plan | IPA | Delegation | Health plan delegates UM, credentialing, claims |
| Health Plan | ACO | Value-Based Contract | Shared savings/losses arrangement |
| Health Plan | FQHC | Contracted Provider | Enhanced reimbursement, safety-net access |
| Health Plan | TPA | Administrative Services | TPA administers self-funded employer plans |
| MCO | PHO | Network Contract | PHO provides hospital + physician package |
| IPA | MSO | Service Contract | MSO provides admin services to IPA |
| ACO | IPA | Organizational Overlap | IPA often forms the provider base of an ACO |
| ACO | FQHC | Participating Provider | FQHC serves as primary care in ACO |
| PHO | ACO | Evolution | PHOs often evolve into or participate in ACOs |
| MSO | TPA | Complementary | MSO serves providers; TPA serves payers |
Organization Guides
IPAs — Independent Practice Associations
Physician network contracting, delegated functions, risk arrangements
PHOs — Physician Hospital Organizations
Hospital-physician joint ventures, consolidated contracting
ACOs — Accountable Care Organizations
Value-based care delivery, population health, shared savings
MSOs — Management Services Organizations
Administrative services, billing, credentialing, practice management
TPAs — Third-Party Administrators
Claims processing, self-funded plan administration
MCOs — Managed Care Organizations
Health plan operations, network management, utilization management
FQHCs — Federally Qualified Health Centers
Community health centers, 340B, sliding fee, UDS reporting
Health Plans — Commercial, MA, Medicaid
Full health plan operations across all lines of business