Provider Network/ Providers/ Specialty Networks
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Specialty Networks

Manage specialty sub-networks, carve-outs, delegated arrangements, and vendor assignments

Cardiology Network
Specialty · In-House
Active
23
Providers
8,240
Members
Delegated: No
Oncology Network
Specialty · Delegated
Active
12
Providers
1,820
Members
Delegated: Yes
Mental Health Network
Behavioral Health · Delegated
Adequacy Gap
45
Providers
14,200
Members
Delegated: Yes
DME Vendors
Ancillary · External
Active
8
Vendors
3,100
Members
Delegated: Yes
Vision Network
Ancillary · External
Active
34
Providers
9,800
Members
Delegated: Yes
Dental Network
Ancillary · External
Active
67
Providers
18,400
Members
Delegated: Yes
Provider Assignment — Cardiology Network
Dr. Robert Patel, MD
Cardiology · Interventional
Active
Dr. Sarah Nguyen, MD
Cardiology · General
Active
Dr. Kevin Brown, MD
Cardiology · Electrophysiology
Active
Dr. Anita Sharma, MD
Cardiology · General
Inactive
Riverside Heart Institute
Group Practice · 6 cardiologists
Active
Dr. Thomas Grant, MD
Cardiology · Pediatric
Credentialing
Carve-Out Rules & Delegation
Delegated Services
Mental health outpatient — Delegated to Behavioral Health Partners LLC
Pharmacy benefit — Delegated to PharmaCare PBM
Vision benefits — Delegated to EyeVision Network Inc
Dental benefits — Delegated to DentalFirst Group
Excluded Services
Experimental gene therapy — Not covered, not carved out
Cosmetic procedures without medical necessity — Excluded
External Vendor Assignments
DME — MedEquip Solutions (primary), HealthSupply Co (secondary)
Dialysis — DaVita preferred network (exclusive carve-out)
Network Performance Metrics
Cardiology Network
4.8 days
Avg TAT (Auth to Service)
4.4 / 5
Member Satisfaction
Mental Health Network
22.3 days
Avg TAT (Auth to Service)
3.6 / 5
Member Satisfaction
Dental Network
3.1 days
Avg TAT (Auth to Service)
4.7 / 5
Member Satisfaction
Page Guide — Specialty Networks
Overview
Specialty networks are sub-networks of the overall provider network organized by specialty or service type. They can be managed in-house or delegated to a specialized vendor.
  • Click any network card to load its provider list
  • Use the toggle to activate or deactivate a network
  • Delegated networks require regular oversight reports
Provider Assignment
Check/uncheck providers to add or remove them from the selected network. Providers must be credentialed before they can be assigned to any network. Changes are saved immediately when you click "Save Changes".
Carve-Out Rules
Carve-outs delegate specific benefit categories to external vendors. CMS requires documentation of delegation agreements and oversight audits at least annually. Excluded services must be clearly defined in the member EOC.
Performance Metrics
TAT (turnaround time) measures average days from authorization approval to first service appointment. High TAT in mental health is a known network adequacy concern driving recruitment efforts.