PROVIDER PERFORMANCE

What could your plan achieve with a higher ratio of high-performing providers in your network? SKYGEN USA’s Provider Performance uses a rating methodology that helps determine which providers are the best stewards of the programs you administer. SKYGEN USA’s provider performance ratings are designed to measure the appropriateness and efficiency of care delivered by each provider, enabling payers to reward high-performing providers with increased referrals or higher reimbursements, while reducing and preventing fraud, waste, and abuse.

SKYGEN USA’s Provider Performance examines:

• Code Ratios - preventive to restorative services, restorations to sealants, surgical to simple extractions
• Frequencies - services per visit, radiographs per patient, extractions per member
• Track record on authorizations
• Member complaints
• Accuracy in claims submission
• Fraud, Waste and Abuse (FWA)
• Electronic adoption - claims, authorizations, direct deposit