Group Practice Journal
In an increasingly complex healthcare environment, it is difficult to verify that payers are complying with contract terms. Built on years of reimbursement knowledge and industry best practices, Experian Health Contract Management and Analysis represents an innovative approach to verifying the accuracy of payments received from third-party payers and ensures your contracts are negotiated with the most favorable terms.
Monitor payer compliance with contract terms, value claims and audit remittances based on the latest payment rules and adjudication logic. This powerful technology platform enables hospitals and facilities to manage multiple payer contracts and reimbursement methodologies. By accurately pricing claims and comparing actual allowed amounts to expected amounts, this market-leading product pinpoints variances quickly and efficiently. The contract management solution is built to adapt to changes within the industry so you can capitalize on emerging reimbursement schemes and changes in payer payment policies.
Conduct contract-based appeals and recover lost revenue with data-driven insight. In addition to providing the details needed for successful appeals and streamlining communications with payers, Contract Management identifies sources and patterns of errors so any recurring issues can be promptly resolved.
Contract Analysis supports the modeling of proposed contract terms and tailors your negotiation strategies to the factors that impact reimbursement the most. Contract Analysis not only assesses the financial impacts of new and proposed contracts right down to how much an individual service line could gain or lose. It also enables hospitals to strategically evaluate overall contract performance and assess the potential introduction of new lines of business.