Contract Negotiations

Managed Care Contracting Analysis and Negotiation

Provider organizations are facing unprecedented challenges to maintain financial stability
in a rapidly changing marketplace. Understanding the terms, language, and rates of
managed care contracts is critical to financial success of an organization. PHCG provides
managed care contract review and analysis, fee schedule analysis, and contract
negotiations.

Contract Review and Analysis – PHCG will provide a contract summary that outlines key
terms and effective dates, guidelines on contract changes, time sensitive information on
notices, claims filing, payments, and termination guidelines.

Fee Schedule Analysis – Managed care contracts typically present reimbursement rates
in plan-specific ambiguous language that does not provide a clear understanding of the
actual reimbursement rates. In addition, the plan-specific language prevents providers
from an actual “apples-to-apples” comparison between contracts. PHCG will prepare a
side-by-side code specific review of fees from contracted plans that will provide a “snap
shot” of all reimbursements identifying the best and least favorable rates. This information
can also be loaded into the patient management system as a tool to monitor accuracy of
payments.

Managed Care Negotiations – Negotiating managed care contracts requires an
extensive knowledge of the managed care contracting process and environment. PHGC
will provide guidance through the often daunting process by identifying what terms can
realistically be negotiated as well as a time lines for finalizing agreements and when and
how to approach renegotiation at the time of contract renewal.