Commercial and government payer contracting
We assist our clients with contract negotiations with all commercial payers (Blue Cross, Aetna, United Cigna, etc.) and government payers (Medicaid MCOs and Medicare Advantage plans). Our client relationships begin with an initial consultation to discuss your needs, expectations and goals, and explore how we can assist you.
Reimbursement review and negotiation
We will analyze your current fee schedules, patient mix, frequently billed procedures and more, and recommend a strategy for higher reimbursement. You are kept informed at each step throughout this process, and the final decisions are yours. We work directly with the payer’s representative, so you don’t have to.
It is surprising how often insurers use the wrong fee schedule, or fail to update their claims system with a newly negotiated reimbursement. We conduct audits to ensure that your practice is being paid according to the terms of your contract.
Resolving claim problems
Inappropriate claim denials are unfortunately common with all payers, and getting a payer to reverse a denied claim requires persistence and an insider’s knowledge of the process. We can help resolve inappropriate denials so that you receive the proper reimbursement for your services.
Building effective payer relationships
Clear and timely communication creates positive business relationships. We understand the payer market and we talk the payer language. We help your practice connect in an efficient, productive and cordial manner with the right payer representative at the right time, so problem-solving becomes easier.
A signed contract is just the first step to an in-network relationship. We can handle all the paperwork to expedite the credentialing process, including payer applications for new providers in your practice, and maintain your credentialed status with CAQH updates and re-attestations.