4 best practices for your physician portal

Provider portals aren’t the most exciting topic. But when it comes down to it, they are one of the most effective ways for healthcare payers to achieve their goals. Your physician portal can help you build relationships with providers, improve member health, and reduce costs. Now that is pretty exciting.


The key is to look at your portal as more than just a portal. Consider the following:


Reimagine your touch points with providers


When building a portal, most plans focus on what providers need from an administrative standpoint:


  • Is the patient eligible?
  • What benefits are covered?
  • Where is the formulary?
  • How will I be reimbursed?
  • What happened to the claim I submitted?


To build a better portal, look past the basic business transactions and think about at all the touch points you have with providers. How can you make them more effective and efficient using technology? For example, you could use your portal to:


  • Accept demographic changes (new location, no longer accepting new patients, doctor retired, etc.)
  • Accept claims appeals
  • Manage preauthorization requests
  • Handle authorization and referral requests
  • Alert providers about gaps in care for members
  • Alert providers about changes in the network


The best provider portals are doing all those things electronically – creating a better experience for providers and eliminating the cost of paper, faxes, and phone calls.


Provide the financial reports providers want and need


With the transition to value-based care, the financial relationship between payers and providers must be more transparent. Strengthen your connection with providers by using your physician portal to communicate about finances. That includes:


  • How the provider is performing under financial portion of contract (including a list of cases assigned)
  • How that relates to pay-for-performance contracts
  • The provider’s potential to collect under those programs


Move the needle on member health


A well-done portal can support care coordination and clinical decision-making. Some ways to do that:


  • Show more than claims data – show as much as you can about lab results, prescriptions filled, etc.
  • Send preventive care reminders to physicians – ask them to engage the member
  • Post care plans – help the provider see who else is involved in the patient’s care, including the care manager


Make your portal the “source of truth”


Finally, I know this seems like a given, but it must be said: be sure your portal holds all of the documents your providers need – including provider manuals and other procedures – all in one place. And make sure the most recent version is always on the portal. You never want to send the message that your portal is out of date.




Chuck Rolfsen is Chief Revenue Officer for Healthx. He helps Medicaid health plans, commercial health plans and other Healthx clients develop strategies to streamline administrative processes and improve the quality of care.