Key Characteristics of a High-Performing Provider Relations Department

 Orchid’s Provider Relations Department is a vital piece of our company, responsible for pairing injured workers with high-quality providers skilled in the nuances of treating workers’ compensation cases. In the workers’ compensation industry, there are a rigid set of characteristics that define a high-performing Provider Relations Department.  At Orchid, we are proud to say that we meet or exceed all of these characteristics through our comprehensive provider management strategy.

The first of these characteristics is a robust network of high-quality providers who are returned-to-work focused. Orchid boasts a proprietary network of over 30,000 contracted and trusted providers nationwide. Our internal provider relations team oversees the continued expansion and quality of our provider network. This team is responsible for oversight of evaluating, credentialing and re-credentialing providers, educating providers, addressing provider issues, and maintaining the integrity of our network.  We train and educate all providers within our network, whether they require a brief update or an entire instruction on our standard operating protocols.

Orchid follows the National Committee for Quality Assurance (NCQA) guidelines for credentialing and quality standards and thoroughly vet providers with medical oversight from our board-certified, Medical Director, Dr. Rick Hartker. Hartker provides clinical guidance and consultation to clients as well as quality reviews of network providers. Dr. Hartker had a direct influence in establishing Orchid’s proprietary provider ranking system; a system that tracks key performance metrics to enforce service level expectations such as billing compliance, schedule accessibility, report timeliness and quality, and feedback from clients and injured workers. The methodology behind the system ranks network providers by accreditation and performance metrics.

To become part of our network, providers must first pass our credentialing process which includes a screening checklist of over 25 requirements covering the following qualifications: the provider has a primary state license and DEA registration; the provider has specialty board certification along with medical education and professional training for non-board-certified providers; the provider must produce a full history of malpractice claims and coverage details. These standards are then evaluated by Dr. Hartker at monthly credentialing meetings.

Beyond our provider relations department, Orchid’s clinical resources play a key role in managing provider quality. For example, our nurses support internal provider management processes by overseeing that providers are held accountable for upholding quality performance standards. Network providers must provide for clinical notes, ease of scheduling appointments, timeliness, ease of access to clinical managers, cancellation rates. Orchid is committed to providing quality treatment and results as well as timely delivery of these results.