AI-powered network management gives health plans a competitive edge by improving data accuracy and strengthening compliance. By applying intelligent automation throughout the network lifecycle, plans can operate with greater confidence while reducing administrative burden and overall cost.
| Traditional | NetworkIQ |
|---|---|
| Disconnected tools that create data silos and inefficiencies |  Centralized data and workflows reduce operational overhead and eliminate silos |
| Manual reconciliation creates an administrative burden across platforms | Unified SSO platform for end-to-end provider network management |
| Limited visibility into network performance and compliance risk | Complete visibility into network adequacy and performance |
| Inaccuracy in provider data, resulting in “ghost locations” | AI-validated provider data adequacy insights |
| Minimal guidance for closing network gaps, requiring costly provider outreach | Actionable recommendations for gap closure and strategic provider recruitment |
HiLabs AI-powered network management solution helps payers stay compliant with evolving regulations and enter new markets with confidence. Accurate provider insights support smarter network adequacy and more effective provider performance optimization, ul
Reduction of ghost networks with no impact to adequacy
Reduction in time to close provider gaps
Cost savings over legacy vendors
MCheck® NetworkIQ brings together multi-source provider data optimization using advanced machine learning models that help health plans build compliant and performant provider networks.
NetworkIQ integrates data from internal systems, credentialing feeds, claims and utilization files, and other third-party sources. A unified data pipeline reconciles these inputs, so health plans can rely on a single, consistent provider dataset.
NetworkIQ uses the HiLabs R3 engine to evaluate each provider attribute for reliability, recency, and relevance. This proprietary algorithm resolves conflicting records, identifies ghost locations, and assigns confidence scores, giving health plans the accurate provider data required for dependable network adequacy analysis.
NetworkIQ uses a combination of genetic algorithms, linear programming, and geospatial analysis to understand true network coverage and access. These models identify gaps, calculate specialty and capacity loads, and highlight where additional providers are needed to maintain compliance or competitiveness.
NetworkIQ enriches provider profiles with quality indicators, cost metrics, and internal performance data. AI-driven prioritization then ranks providers based on expected adequacy impact, cost-effectiveness, and your configured business rules; ensuring your network team focuses on the providers who will make the greatest difference.
Every interaction—whether adding a provider, adjusting thresholds, or running new scenarios—feeds into NetworkIQ, forming a continuous learning loop. Over time, the platform becomes even more accurate and efficient in predicting network needs and identifying optimal provider opportunities.
NetworkIQ offers a clean, intuitive interface, allowing users to:
View network gaps on interactive geospatial maps
Compare provider rankings and profiles
Run “what-if” simulations to model adequacy changes, and
Export compliance-ready reports
A national health plan used AI-driven insights from NetworkIQ to identify adequacy gaps and improve provider coverage across multiple markets. The solution reduced manual effort while strengthening compliance and overall network performance.
HiLabs AI-powered R3 algorithm, featured in JAMA, leverages 1000s of publicly available sources in real time combined with advanced geospatial technology to cleanse over 97% of ghost networks with no impact to payor network adequacy
HiLabs AI-powered NetworkIQ auto-recommends high-performing and marketable providers for optimal network design while ensure network adequacy compliance
HiLabs automates data validation, multi-source aggregation, and adequacy analysis in one platform—cutting costs by 40% and replacing fragmented, manual legacy processes
Purpose-built platforms that bring accuracy, intelligence, and automation across provider data, networks, contracts, value-based care, and clinical operations.
Access expert guidance on healthcare provider network management, including best practices and trends designed for complex environments.
