OpenNetworks isn't another health plan and it isn't a narrow network. It's a technology platform that gives you control over your own rates, terms, and employer relationships.
Set different rates tied to different business terms to meet market requirements. Present clear, consistent rules for payment, pre-authorization thresholds, and audits — visible to everyone on the platform. Purchasers select providers to participate based on the rates and terms you've published.
Develop specific rate sheets for targeted purchasers via the OpenNetworks platform. Submit claims through your existing systems, workflows, and clearinghouses — OpenNetworks handles the business logic behind applying the correct rates and terms to each claim.
OpenNetworks captures the full claim resolution cycle, giving purchasers and providers the information needed to monitor contract adherence. Participating providers get free, aggregated market data. Incentives are aligned through flat per-employee access fees — never a cut of savings.
Publish rates and terms based on your own market position.
Purchasers include you in the custom networks they build.
Members use their OpenNetworks ID; you verify eligibility as normal.
Claims are repriced and routed automatically, per your agreed contract.
OpenNetworks policies, procedures, and administration.
Learn more →An overview of the OpenNetworks platform.
Learn more →Answers to the most common provider questions.
Learn more →OpenNetworks is an open platform bringing together purchasers seeking transparently-priced healthcare services and providers willing to deliver those services on clearly defined terms. Purchasers select and curate custom provider networks from participating providers and pay a flat, per-employee fee for platform access.
OpenNetworks isn't an insurance plan or TPA and doesn't take on insurance risk. It charges a flat per-employee-per-month fee — no hidden fees, no percent-of-savings charges — and is open to all providers, with no competitive exclusions or gag clauses.
No — OpenNetworks isn't one fixed network. It's a national platform enabling providers to deliver unique value propositions based on rates tied to detailed business terms, so self-funded employers can configure networks suited to their specific needs.