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Payer Contract Management and Analysis

Improve Contract Management and Performance

In an increasingly complex healthcare environment, it is difficult to verify that payers are complying with contract terms, whether negotiated as a larger enterprise or single medical group. Built on years of reimbursement knowledge and industry best practices, Experian Health Contract Management represents an innovative approach to verifying the accuracy of payment received from third-party payers.

Validate Reimbursement Accuracy

Monitor payer compliance with contract terms, value claims and audit remittance based on the latest payment rules and adjudication logic. This powerful technology platform enables providers to manage multiple payer contracts and reimbursement models, including complex hospital, ambulatory surgical center and medical group agreements. By accurately pricing claims and comparing actual reimbursement to expected payment, this market-leading product pinpoints payment variances quickly and efficiently. The payer contract management solution is built to adapt to changes within the industry so you can capitalize on emerging reimbursement models, such as Accountable Care Organizations (ACOs).

Recover Underpayments

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.

Negotiate More Favorable Terms

Model proposed contract terms and tailor your negotiation strategies to the factors that impact reimbursement the most. Contract Analysis not only assesses the financial implications of new and proposed contracts right down to how much an individual provider could gain or lose, but it also enables healthcare organizations to strategically evaluate overall contract performance and assess the potential introduction of new lines of business.

Additional benefits include:

  • Improved tracking of chargemaster accuracy
  • Streamlined workflow with claims auditing across an organization
  • Lower billing and contract administration costs
  • Fewer registration, coding and posting errors
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