Are health plans complying with your contract terms? Verify the accuracy of payment received from third-party payers and negotiate successful contracts.
With Experian Health’s Contract Manager and Contract Analysis for medical groups, you can verify your organization is getting the payer revenue it is due. These powerful solutions continuously audit payer contract performance so you’re assured your collections align with negotiated terms.
Validate reimbursement accuracy
Contract Manager for medical groups monitors payer compliance with contract terms and values claims and audits remittances based on the latest payment rules and adjudication logic. Medical groups can easily manage multiple payer contracts and reimbursement methodologies. The integrated solutions pinpoints variances quickly and easily, accurately pricing claims and comparing actual payer allowed amounts to expected amounts. Because our contract tools are built to adapt to changes within the industry you capitalize on emerging reimbursement schemes and continuously monitor changes to ensure accurate reimbursement.
Conduct contract-based appeals and recover lost revenue with data-driven insight. In addition to providing details needed for successful appeals and streamlining communications with payers, Contract Manager identifies sources and patterns of errors so recurring issues can be promptly resolved.
Negotiate favorable terms
Contract Analysis supports modeling of proposed contract terms so you can tailor negotiation strategies to optimize reimbursement. It also assesses financial impacts of new and proposed contracts down to how much individual service lines could gain or lose, and lets groups like yours strategically evaluate contract performance and assess potential of new lines of business.
You improve contract management with Experian Health’s Contract Manager and Contract Analysis for medical groups. These powerful solutions continuously audit payer contract performance so you’re assured your collections align with negotiated terms.
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Works Well With
Revenue Cycle Business Intelligence
Now available in Contract Manager for Medical Groups: Interactive graphs that allow drill-down and drill-through functions to expose source claim data, as well as practice management system specific data attributes.