Payor Contract Negotiations
We negotiate directly with commercial payors to maximize your reimbursement rates. Most practices are leaving significant revenue on the table in contracts that have never been reviewed.
Schedule a ConversationYour contracts are probably underperforming
The average independent practice has not reviewed its payor contracts in three or more years. In that time, costs have risen, volumes have changed, and market rates have shifted. The result is that most practices are reimbursed at rates that no longer reflect the value they provide.
We bring data, market intelligence, and negotiation experience to every engagement. Our goal is to increase your rates where the opportunity exists and to ensure your contract terms are fair and enforceable.
Data-driven approach
We benchmark your current rates against market data before any negotiation begins, so we know exactly where the opportunity is.
Specialty expertise
We understand the procedure codes and reimbursement patterns specific to your specialty, which makes our negotiations more targeted and effective.
Included with RCM
For full RCM clients, contract negotiation support is included. No separate engagement or additional fee required.
Standalone option
If you manage your own billing, we offer contract negotiation as a standalone service. We do the analysis and negotiation; you keep your billing team.
Frequently asked questions
Payor contract negotiation is the process of reviewing, renegotiating, and optimizing the fee schedules and terms in your contracts with commercial insurance companies. Most practices are reimbursed at rates set years ago that have not kept pace with costs. Negotiation can meaningfully increase your revenue without adding a single patient.
We analyze your current reimbursement rates by payor and procedure code and benchmark them against market data for your specialty and geography. In most cases, we identify specific contracts where rates are 10 to 30 percent below market, which becomes the basis for negotiation.
We negotiate with all major commercial payors, including UnitedHealthcare, Aetna, Cigna, BCBS, and regional plans.
Timelines vary by payor and contract complexity, but most negotiations are completed within 60 to 120 days. We manage the entire process and keep you informed at each stage.
Yes. For clients using our full RCM service, payor contract review and negotiation support is included as a standard component. It is also available as a standalone engagement for practices that manage their own billing.
Find out what your contracts are worth
A contract analysis takes less time than you think and often reveals revenue opportunities that pay for themselves many times over.
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