OpenNetworks How It Works Visual December 2024

1.

How It Works
Visual Concept for website and solution sheet
Updated 11/27/24

2.

How the OpenNetworks Marketplace Works
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OpenNetworks
provides comprehensive
market data to providers and
employers
Healthcare systems and
providers choose their rates
and terms from a
standardized list
Providers join the
platform and appear
based on their
contracted rates and
terms
Co-pays directly to
providers
Bespoke network
Standard processing
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Provider submits claim in 837
format to OpenNetworks
directly or via clearinghouse
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Employer or TPA verifies
eligibility according to
contract terms
Fast payment
Brokers and employers build benefit
plans with terms from a standardized
list and curate custom provider
networks to deliver benefits
Employers pay flat fee- peremployee to OpenNetworks for
platform access
Employees utilize
services that are “in
network” for their
custom plans
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Providers who meet volume
thresholds are also eligible
for profit sharing
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OpenNetworks processes
claim according to rules
of employer’s benefit plan
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Employer or TPA pays
provider, employee pays costsharing balance. Oppy for 3rd
party revenue collections