How To Navigate Your Payer Contracts

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You have payers with which you contract. Are you keeping up with those contracted relationships to ensure you receive maximum reimbursement? Make it a business-healthy habit to stay on top of and navigate your payer contracts:

  • Be familiar with your contracts. Know the payers and networks with which your practice contracts. If you work with any narrow networks, reach out to primary care physicians to take advantage of referrals. Make sure that you keep an updated list of all contracted payers and understand the terms of each, including negotiated payment rates. Review the list periodically to ensure that the terms of these contracts still meet the needs of your practice.
  • Monitor payer performance. Keep aware of which in-network payers provide the highest average payments. Track payment quality - are there any payers that require a lot of follow-up? Make sure your payments align with the negotiated rates. You've already agreed to contract terms and can hold those payers accountable to them to maintain your in-network status.
  • Track applicable dates. It's essential to stay on top of all the various renewal and expiration dates, as well as when new contracted fee schedules go into effect. Checking these will help you renegotiate new contracts most effectively as well as apply any changing payment rates on a timely basis.
  • Dig into the details. Review these items for every contract: term; rate - fixed or rolling; termination date; any carve-outs; provider specialty terms; bundled payments; fee schedule changes; provider enrollment guidelines; authorization needs; referral guidelines.

If this sounds overwhelming and a burden to your already-busy staff, outsourcing payer enrollment can improve the accuracy and timeliness of all provider enrollments and re-attestations. With payer enrollment expertly managed for you, your staff will be freed up for other more patient-focused duties.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.