With the financial pressures facing providers today, payer contract review and negotiations are more important than ever before.  It is critical to have the right strategy and negotiation tactics to achieve the strongest language protections and rate terms with payers. In addition, achieving revenue growth and margin improvements through new payer payment models such as bundled and episode of care, risk-sharing, and other value-based and accountable care payment models are critical for financial success. 

Managed Care Systems Group’s Payer Relations and Contracting professionals have over 60 years of strategic payer and provider negotiation experience on both sides of the fence. Having extensive experience representing both payers and providers gives us a unique perspective and advantage contracting with payers on behalf of provider clients. 

Provider clients who don’t have a payer contracting professional on staff recognize the critical importance of using a seasoned payer contracting consultant to implement a payer contracting strategy that directly bolsters financial performance. Managed Care Systems Group realizes the importance of working with clients to develop tailored solutions based on the client’s payer strategy and the payer contracting demands of the market.

Managed Care Systems Group’s scope of work includes pre-negotiation to post-negotiation payer contracting work, as mutually agreed upon with our clients and strictly based on the needs of each client. Such contracting work may include any of the following services as requested by our clients, including:

✓ Payer Market Research and Strategic Planning

          Payer market assessment

          Payer contracting/re-contracting opportunity analysis

          Strategic payer contracting plan

✓ Payer Contract Negotiations and Negotiation Support

          Fee-for-service and value-based reimbursement modeling and analysis

          Payer contract reimbursement proposals and counterproposals

          Payer contract language review and drafting

          Payer contract negotiation and negotiation support

✓ Miscellaneous Payer Relations and Contracting Needs

          In-service payer contract education

          Payer contracts document updates for internal staff use

          Claim resolution requiring payer escalation

          Revenue Cycle Management consultation

          Payer contracting presentations preparation

          Out-of-Network payer analysis, reimbursement, and strategy

          Value-based contracting initiatives consultation

          Payer Joint Operating Committee support