Provider Network
Management.
Your AI Strategist for Network Performance Optimization. AI analyzes provider network performance across cost, quality, utilization, and patient outcomes. Identifies gaps and over-saturation, benchmarks providers against peers, and models the financial impact of network changes. Powers smarter contract negotiations with data-driven insights.
Know your network. Optimize it in real-time.
Performance scoring, gap analysis, financial modeling, and contract intelligence — all powered by AI.
Performance Benchmarking
Score every provider on cost, quality, utilization, and patient outcomes. Benchmark against peers in the same specialty and geography in real-time.
Gap & Saturation Analysis
Identifies network gaps by specialty and geography. Flags over-saturated areas. Recommends credentialing priorities to balance coverage and cost.
Financial Impact Modeling
Models the MLR impact of adding, removing, or steering volume between providers before decisions are made. Simulates contract scenarios.
Contract Intelligence
Powers smarter negotiations with data-driven insights. Compares fee schedules, utilization patterns, and value across your network.
Volume Steering Recommendations
AI recommends optimal volume distribution across providers to minimize MLR while maintaining access and quality standards.
Network Leakage Monitoring
Tracks out-of-network utilization in real-time. Identifies leakage patterns by member segment, geography, and specialty. Recommends corrective actions.
From raw data to network strategy.
Optimize MLR. Reduce leakage. Steer smarter.
MLR ↓
Optimized medical loss ratioSteer volume to high-value providers based on real-time performance data. Reduce out-of-network costs and network leakage with targeted recommendations.
Data-led
Contract negotiationsReplace relationship-based pricing with objective benchmarks. Compare fee schedules, utilization patterns, and provider value across your entire network.
Fewer
Balance-billing surprisesMembers get better access to quality, in-network providers. Gap analysis ensures coverage where it's needed. Fewer out-of-network incidents.
Asia-built
Globally exportableBuilt where the gap is largest — insurer-provider relationships across Asia are managed via spreadsheets and opaque negotiations. Adapts to any market's provider landscape and regulatory framework.
Plug into existing systems or run natively.
Standalone via Open API
Feed claims and provider data via API. Receive provider scores, gap analysis, and financial models. Export to your credentialing or network management platform.
Native on Mazecare Insurance OS
Network intelligence runs on live claims data. Provider performance updated in real-time. Recommendations surface directly in your payer workflow.
AI Model Agnostic. Your AI, Your Choice.
Choose or bring your own models for provider scoring, network optimization, and financial modeling.
Pre-integrated Models
Provider scoring and network optimization models tuned for health insurance, ready out of the box.
Open-source Models
Run open-source analytics within your own infrastructure for full data sovereignty.
Custom Fine-tuned
Train on your network's historical performance data for market-specific accuracy.
Bring Your Own API
Connect any external analytics engine, scoring API, or network management platform.
AI-native network intelligence vs. spreadsheets.
| Feature | Legacy TPAs | Availity / Zelis | Manual / Spreadsheets |  |
|---|---|---|---|---|
| Real-time provider scoring | Partial | |||
| AI-driven gap analysis | Limited | Manual | ||
| Financial impact modeling | Limited | |||
| Volume steering recommendations | ||||
| Contract negotiation insights | Partial | Manual | ||
| Network leakage monitoring | Basic | Manual | ||
| Credentialing prioritization | Partial | Manual | ||
| Provider benchmarking | Partial | Limited | ||
| Claims data as input (structured) | Partial | Partial | ||
| Continuous learning | ||||
| Embedded in payer workflow | Partial | Partial | ||
| Own AI-native OS | Mazecare OS |
Frequently asked questions.
AI scores each provider across cost efficiency, clinical quality, utilization patterns, and patient outcomes. Scores are benchmarked against peers in the same specialty and geography, updated continuously as new claims data flows in.
Yes. Gap analysis maps your network coverage against member distribution, utilization demand, and specialty needs by geography. It flags underserved areas and recommends credentialing priorities with projected ROI.
You can simulate adding or removing providers, adjusting fee schedules, or steering volume — and see the projected impact on MLR, out-of-network costs, and member access before making any changes.
No. It gives your network team real-time intelligence that replaces spreadsheets and gut feel. Decisions still rest with your team, but now backed by data-driven recommendations and financial projections.
Yes. Provider scores, gap analysis results, and credentialing recommendations export via API to any existing credentialing or provider management platform.
Yes. The engine adapts to local provider landscapes, fee structures, and regulatory frameworks. Built in Asia where network management is most opaque, but fully exportable to any market.
Ready to optimize your network?
See AI-driven provider scoring, gap analysis, and financial modeling on your own network data.