Five steps toward a more effective provider portal

Struggling to prioritize your provider portal? Though it may not seem mission critical, an effective provider portal can play an essential role in helping healthcare payers achieve their goals. With the right planning, your physician portal can help you build relationships with providers, improve member health, reduce costs, and more.

The key is to think of your portal as more than just a portal. Consider these five steps to make your provider portal an effective part of your strategy.

Focus first on the fundamentals

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?

Just because most plans already include this information, don’t overlook its significance. In their annual Payer View surveyPhysicians Practice and AthenaHealth rank payers based on how well they do at transparency, accuracy, and reliability in these areas because they are so mission-critical to providers.

Revisit these key functions on your own portal to ensure that providers can easily get the information they need.

An easy-to-use provider portal means your call center will be reserved for more complex issues or provider representatives who need personal attention.

Reimagine new touch points with providers

Don’t stop with the fundamentals, though. To build a better portal, look past the basic business transactions and think about all the touch points you have with providers. How can you make them more effective and efficient using healthcare technology? For example, you could use your portal to:

  • Accept claims appeals.
  • Manage preauthorization requests.
  • Handle authorization and referral requests.
  • Alert providers about gaps in care for members.
  • Notify 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.

Also, be sure your portal can accept demographic changes (new location, no longer accepting new patients, doctor retired, etc.), especially with the risk of penalties for outdated provider directories and under the watchful eye of consumer groups who want to help patients avoid out-of-network bills.

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. But according to a 2015 Health Leaders Media survey, trust between the two groups continues to be an issue. Thirty-nine percent of providers surveyed said that “trust with commercial payers needs to be improved.”

Strengthen your connection with providers by using your physician portal to communicate about finances.

That includes:

  • How the provider is performing under the financial portion of your contract (including a list of cases assigned).
  • How the provider is progressing under pay-for-performance contracts.
  • How the provider will potentially collect under those programs.

Move the needle on member health

A well-designed portal can also support providers in care coordination and clinical decision-making. Consider the following:

  • Show more than just claims data; include lab results, prescriptions filled, etc.
  • Send preventive care reminders to physicians and ask them to engage the member.
  • Facilitate post-care plans by showing the provider who else is involved in the patient’s care, including the care manager.

Payers and providers cooperatively sharing health information, as in the case of western New York’s HEALTHeLINK exchange, improves patient care, helps lower costs, and enhances trust and communication between payers and providers.

Make your portal the “source of truth”

Finally, though it may seem obvious, be sure your portal holds all of the documents and resources your providers need—including provider manuals and other procedures—all in one place. And always update your portal when new versions of documents become available. Avoid the appearance (or reality) that your portal is out of date.
Your provider portal may not always sit at the top of your priority list, but with a little planning, it can become a central part of your provider collaboration strategy. Takes these steps today to create a more effective portal.


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.