Defining Provider Network and Product

Summary

Summary

Provider

  • A person or organization that supplies a member with care or services
  • Can either be Persons (P-type provider) or Organizations (O-type provider) in the Kyruus Connect for Payers data
  • Uniquely defined by the provider key/location key combination

Network

  • The providers, persons and/or organizations, that a health plan groups together and make available to members
  • Uniquely defined by the Local Network Code and the Provider Network Code, which need to be the same in order for the provider to be findable in any given search

Product

  • A network or group of networks that represent the providers available for a given member, identified by a marketable name
  • Defined in the Kyruus Health data by the assignment of a product code
  • Product code defines the providers that are available to members