Our mission is to work alongside your team to optimize the delivery of specialty healthcare, guided by advanced analytics and our NCQA Accredited UM Program while adhering to regulatory requirements and information systems security guidelines. PNS focuses on providing member access and improving clinical outcomes, as well as member and provider satisfaction.
Join the many health plans already benefiting from quality clinical outcomes and cost containment affording them operational efficiency and specialty risk management.
As a full-service specialty care management company and Third-Party Administrator, PNS delivers maximum benefits to its partners through compliance to industry standards, physician-led managed networks, specialty trained staff, and robust business informatics.
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 that the delivery of health care is appropriate, cost-effective, and of high quality under the NCQA Accredited guidelines.
Although we are not delegated for credentialing, we align with your credentialing requirements and 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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Call Us Today – (888) 959-8714
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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