Wise Provider Networks

WISE PROVIDER NETWORKS

CREDENTIALING PROCESS

Wise Provider Networks will process your credentialing file prior to finalizing a contract for participation in the Wise Provider Network. This process can take up to 60 days. The process is typically expedited by the retrieval of credentialing files through CAQH.

CAQH is an online database which gathers provider credentialing information that can be accessed by multiple organizations that choose to participate with CAQH. The service is free of charge to providers and greatly reduces the time-consuming task of completing multiple credentialing applications. To obtain more information about CAQH, please visit www.CAQH.org or click on the following link to access CAQH and set up your account – https://caqh.geoaccess.com/oas.

If you are currently a member of CAQH, please provide your CAQH number as soon as possible in order to assure that your credentialing file can be expedited. Please make sure that your CAQH file is updated with a current attestation statement. Also, you will need to authorize Wise Provider Networks to access your information. Therefore, if your file is not set up for global authorization, you will need to login and add Wise Provider Networks.

If you have questions or require help with the process, you may contact the CAQH Help Desk at 1-888-599-1771.

If you elect not to participate with CAQH, please complete the Wise Credentialing application. Once completed, please return the completed application with all required copies and your file will be processed.

For Credentialing Questions Only - You may contact the Wise Credentialing Department at mailto:Carey@wiseprovider.net.

Who is Wise?

Wise Provider Networks recognizes the importance of providing high quality health care at an affordable price. At Wise, these are top priorities. That is why employers ask Wise to create specialized, innovative provider networks to meet employee medical needs.

Wise networks often support employer-sponsored primary care services. Those employees needing specialized care may choose from hospitals, qualified physicians and other providers who participate in a Wise network created expressly for the employer.

Each physician or hospital in a Wise network has been carefully selected to supplement the employer-sponsored primary care clinic with a wide range of specialized services. The goal of this unique partnership is to improve access to the highest quality health care, promptly treat illness or injury, and ensure that health issues are managed effectively and efficiently. To meet this goal, each physician is selected for their achievement in effectively complying with nationally recognized best practice guidelines. Subsequently, the physician is provided with their individual patient’s compliance with best practice guidelines, allowing the physician to better determine gaps in each patients care. This important information allows the physician to raise their efficiency in delivering high quality care to the employer’s population.

Wise employers offer better benefits to members who use the Wise network by reducing co-payments, deductibles and other out-of-pocket expenses. In combination with a reduction in the employee’s out-of-pocket expenses, the physicians in the employer-sponsored clinic proficiently direct members to the Wise hospital system(s) and specialized physician teams. Competition between health care providers to be a part of a Wise network produces a material reduction in the price paid for health care services.

Developing a Wise network is an effective way for an employer to increase the quality of the health care their members receive while at the same time efficiently reducing the expense for health care services. The return-on-investment for a Wise network is (1) a hard dollar savings that can be measured, and (2) a material increase in the employee’s compliance with nationally recognized best practice guidelines which results in a higher quality of care.

Allison Robbins – President

Achievement

Senior Underwriter, Great-West Life Assurance Company: 1989-1993

Received five promotions in five years

Senior Underwriter, IHC Health Plans (Now SelectHealth): 1993-1994

Developed award winning IHC Care/SelectMed dual option strategy

Founded Payer Contracting, Intermountain Health Care: 1994-1997

Increased IHC hospital volume by 150,000 members in 1996

Vice President of Managed Care, HCA the Healthcare Company: 1998-2002

Restructured Utah healthcare market recalibrating Altius healthcare (formerly FHP), BlueCross BlueShield and United Healthcare, credited with a material impact on the stock price. HCA moved from $17 to $48 per share during my tenure

Founded Five-Star Health Solutions: 2002-Current

Founded Wise Provider Networks: 2005-Current

Added over 174,000 members since inception

Creates, implements and manages employer sponsored high performance networks

Sole provider of high performance networks supporting the largest national provider of employer sponsored clinics

Nationally Recognized Speaker on Health Plan Design Innovation: 2007-Current

Bonnie Hansen – Principal Consultant

Experience / Involvement

Principle Consultant: Wise Provider Networks – contracting and managing custom networks – 2005 to Current

Director of Sales and Marketing: Altius Health Plans – 1996 to 2005

Account Executive, Provider Relations Manager and Claims Manager: United Healthcare – 1984 to 1996

Expertise

Twenty-four years experience, Health Care industry with vast experience in sales and marketing

Ten years experience in high level sales negotiations affecting $2 to $5 billion in revenue

Directed the initial sale and ongoing account management of local and national accounts

Broad experience in developing and selling both group and individual insurance products to include fully-insured, partially self-funded, self-funded and network lease products

Proven track record in creative solutions that generated new and renewal insurance revenue

Laura Peifer – Principal Consultant

Experience / Involvement

Principle Consultant: Wise Provider Networks – contracting and managing custom networks

Sales Business Manager – National Accounts & Large Groups: Altius Health Plans – 1988 to 2006

Expertise

Twenty years experience in the Health Care Industry with extensive experience in sales and marketing

Twelve years experience in sales negotiations affecting $2 to $5 billion in revenue

Direct sales and ongoing account management of local and national accounts

Ongoing management of over 75,000 members

Membership retention of 98% for ten years

Broad experience in developing and selling fully-insured, partial self-funded, self-funded and network lease products

Proven track record in creative solutions in generating new and renewing revenue

Jackie Butterbaugh – Network Management

Experience / Involvement

Director of Network Management: Wise Provider Networks – 2007 to Current

Director of Network Management: Coventry Health Care/First Health – 2003 to 2007

Manager of Network Operations: CCN Managed Care, Inc. – 1999 to 2003

Expertise

Over 15 years of experience in the managed care industry, with a proven track record in successful hospital and physician contract negotiations

Network development and management throughout 16 states west of Mississippi

Direct contract negotiation and management with major health systems

Managed network development efforts in Louisiana following Hurricane Katrina

Developed new statewide network throughout Idaho to meet client development needs

Implemented new operation processes and contract protocol training tools for hospitals and physician groups of all size and specialty

Excellent reputation for quality customer service to assist hospital administration, IPA managers and clinic managers to build network support and partnership with providers