Networks — CGS Health

Network access

National & direct networks we build on.

We place each group on the network that fits its footprint — broad national PPOs for distributed workforces, and high-value direct and regional networks where members are concentrated.

National PPO

A broad national PPO for distributed workforces — deep provider access across the country with the contracting strength of one of the largest carriers. Our most common foundation for major-medical plans.

Nationwide Major medical Broad access

National PPO

National Blue-branded PPO access for groups whose members favor Anthem providers and facilities. A strong alternative national foundation with wide reach and recognized provider relationships.

Nationwide Blue-branded Major medical

Direct-to-provider

A direct-contracted network built around Northwell Health's system in the New York metro and Northeast. High-value, system-level pricing and care coordination for groups concentrated in the region.

NY metro / Northeast Direct contract High-value

Regional

A regional network with strong local contracts and provider relationships across the Midwest. The right fit when your members actually live and work where Midlands has the deepest reach.

Midwest Regional Local contracts

Complementary PPO

One of the largest independent PPO networks in the country — its PHCS network is most often layered as a complementary wrap to extend in-network access wherever a primary network is thin. Ideal for members who travel or live outside a regional footprint. (MultiPlan is now part of Claritev, but the network is still branded MultiPlan/PHCS.)

National PHCS wrap Complementary

Network strategies

Two ways to extend value beyond a single network.

Wrapped options

A primary network, wrapped for the gaps.

When a regional or direct network gives the best value in-area but doesn't reach everyone, we wrap it with a secondary network so traveling and out-of-area members stay in-network everywhere they go.

Best-value primary network where members are concentrated
National wrap for travel, remote, and out-of-area care
Seamless member experience — one plan, one ID card
Captures regional savings without sacrificing access

Reference-Based Pricing

Pay a defined, defensible price.

Instead of discounting off inflated billed charges, RBP reimburses providers at a transparent multiple of Medicare — with member advocacy and balance-bill protection built in so members are supported, not surprised.

Medicare-referenced reimbursement methodology
Member advocacy and balance-bill support included
Significant savings versus traditional PPO discounting
Can run standalone or paired with a network

Tiered Network

Featured tiered network

Northwell Direct + Anthem, wrapped into one plan.

Our flagship two-tier network pairs high-value, direct-contracted Northwell care across the NY metro with Anthem's national BlueCard network — lowest cost at the core, full coverage everywhere else. Built, priced, and managed by CGS Health.

Explore Northwell Direct + Anthem →

Also available

Custom structures on top of any network.

Tiered & steerage

Designs that reward members for choosing higher-value providers — lower cost-share for the best facilities, built to your plan.

Narrow & high-performance

A curated subset of top-performing providers for better outcomes and tighter cost control where the population supports it.

Custom regional builds

Layer the networks above by geography and benefit tier to match exactly where and how your members get care.

How we choose

Built around your population — in three steps.

Map the population

We start with where your members live, work, and get care — geography, density, and historical utilization drive the network shortlist.

Model the options

We compare national, regional, direct, wrapped, and RBP scenarios on access and projected cost so the trade-offs are clear before you decide.

Build & steer

We implement the chosen structure — including tiering and steerage — and keep optimizing it as your population and claims evolve.

Find the right fit

Let's model the network strategy for your group.

Tell us about your population and we'll show you the access-and-cost trade-offs across national, regional, direct, wrapped, and reference-based options.

Talk to our team → Back to Solutions

The right network for the population.