3750 N.W. 87th Avenue, Suite #500 - Miami, FL

PNS Provides Creative Solutions for Today's Challenging Healthcare Market

By the Numbers

Members Under Management
0 M+
Number of Specialists
0 +
Unique Specialist Locations
0 +
Years of Success
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Trusted partner delivering its clients the benefit of over 20 years of industry experience with a proven track record of success!

Value-Based Speciality Organization

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 Solutions

Delegated Services

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.

Claims Processing

Claims Processing

A fully licensed and integrated TPA system that handles Medicare, Medicaid, Healthy Kids, CMS T19 & T21 & Commercial line of business

Compliance

Compliance

A strong focus on compliance oversight of all CMS Medicare, Medicaid and Health Plans requirements

Network Development

Network Development

Ensures all state and federal guidelines for member access, accessibility, and provider ratio count are met

Provider Relations

Provider Relations

Works in close partnership with Health Plan partners, providers, and the community's needs to create personalized specialty care solutions for all members

Utilization Management

Utilization Management

Ensures the delivery of health care is appropriate, cost-effective, and of the highest quality under the NCQA Accredited guidelines

Credentialing Intake

Credentialing Intake

Aligned with NCQA guidelines and our Health Plan partners' credentialing requirements, we alleviate initiating the credentialing process for unqualified providers

Line of Business

Medicare

We service and support Medicare Advantage, Traditional Medicare and eligible Medicare members who belong to an ACO. 

Medicaid

We service and support the Medicaid Managed Care population across the State of Florida, including SMMC Specialty Plans.

Healthy Kids

We service and support the Florida Healthy Kids population across the State of Florida.

Commercial

We service and support many of our health plan partners whom have Commercial products, such as, individual, employer and self-funded.

Exchange / ACA / Marketplace

We service and support many of our health plan partners whom have Exchange / ACA / Marketplace products.

Our Specialties

Health Plan Partners