Provider Network Solutions (PNS) is a market leader and innovator that partners with a Third-Party Administrator and an NCQA Accredited Healthcare Utilization Management organization aligning Health Plans, Primary Care Physicians, and Specialists.
Our team is here for you every step of the way. With years of experience and training, we are fully prepared to provide exceptional quality care.
A fully licensed and integrated TPA system that handles Medicare, Medicaid, Healthy Kids, CMS T19 & T21 & Commercial line of business
A strong focus on compliance oversight of all CMS Medicare, Medicaid and Health Plans requirements
Ensures all state and federal guidelines for member access, accessibility, and provider ratio count are met
Works in close partnership with Health Plan partners, providers, and the community’s needs to create personalized specialty care solutions for all members
Ensures the delivery of health care is appropriate, cost-effective, and of the highest quality under the NCQA Accredited guidelines
Aligned with NCQA guidelines and our Health Plan partners’ credentialing requirements, we alleviate initiating the credentialing process for unqualified providers
We service and support Medicare Advantage, Traditional Medicare and eligible Medicare members who belong to an ACO.
We service and support the Medicaid Managed Care population across the State of Florida, including SMMC Specialty Plans.
We service and support the Florida Healthy Kids population across the State of Florida.
We service and support many of our health plan partners whom have Commercial products, such as, individual, employer and self-funded.
We service and support many of our health plan partners whom have Exchange / ACA / Marketplace products.
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At Provider Network Solutions, we’ve worked throughout the company to comply with privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law designed to ensure the privacy of personal and health information. In addition to all federal laws, Provider Network Solutions also complies with all state laws and regulations. If you have any questions or would like to report any issues regarding our Privacy Program, please email our Privacy team at privacy@pns-mgmt.com.
Provider Network Solutions, its subsidiaries, and its affiliates’ certification decisions are based only on the appropriateness of care and service and the existence of coverage. Provider Network Solutions, its subsidiaries, and its affiliates do not reward physician reviewers, case managers, employees, practitioners, or other individuals for issuing denials of coverage or service. Provider Network Solutions, its subsidiaries, and its affiliates do not pay incentives to physician reviewers, case managers, employees, practitioners, or other individuals to reduce the provision of care which is deemed medically necessary. Provider Network Solutions, its subsidiaries, and its affiliates do not give financial incentives to physician reviewers, case managers, employees, practitioners, or other individuals to encourage decisions that result in under-utilization of care or services.
We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. You may access the Nondiscrimination and Accessibility notice by clicking here.
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