Providers to Networks

• Providers are placed into networks by assigning the provider key/location key combination for a given provider at a location to the network code for a given network in the ProvNetworks file
• A health plan determines what the network code will be for each network they create
• A provider can be a member of a single network, or of multiple networks
• If a provider is a member of multiple networks, those networks can be assigned to a single product or to multiple products

Networks to Products

• Networks are assigned to products by aligning the provider’s network code to the product code
• the Local Network Code (field 4 in the ProvNetworks file), and
• the Provider Network Code (field 10 in the ProductNetwork file)
• the Provider Network Code is then mapped to the product code in the ProductNetwork file
• the Local Network Code and the Provider Network Code values must be the same in order for providers to be assigned to products
• A health plan determines what the product code will be for each product they create
• A network can be assigned to a single product, or to multiple products
• The assignment of multiple network codes to a single product code supports the need for tiered products to display tiering information for a provider