Management of Contracts with Medical Payers

Payer contracts in the healthcare industry are notoriously difficult to administer and monitor due to their complexity. They cover everything from provider networks and reimbursement rates to provider credentialing and medical necessity. They specify how healthcare professionals are rewarded for providing services to people covered by specific health plans.

Healthcare professionals often miss claims-filing deadlines and fail to meet the criteria for timely compensation because of the difficulties of keeping up with these agreements and establishing a complete understanding of the many terms and specifics. This can lead to providers missing out on reimbursement payments and incorrectly projecting future income, which is bad for business.

What is Contract Management & Why does Contract Management Software Matter

Because of this, it is essential for hospital and practice administrators to have a thorough understanding of payer contracts to guarantee that their organizations receive full reimbursement for rendered services without wasting time pursuing payment from payers. If you want to administer healthcare payer contracts efficiently, consider the following five suggestions.

Utilize contract management software to manage and preserve payer contracts

With the help of contract management software from, healthcare providers can keep track of all of their payer contracts in one convenient location, eliminating the need to rummage around in shared files every time they need to refer to a specific agreement.

Manual processes take a lot of time and are prone to errors. One example of this is keeping track of contracts manually by copying and pasting the information from the contracts into a spreadsheet. Things have a tendency to become disorganized when multiple people use the same spreadsheet at the same time.

Delve deeper into contract wording

Those who are tasked with the responsibility of monitoring payer contracts need to have a strong understanding of the language that underpins these agreements in order to decode the typical roadblocks, which include repeating terminology and standardized standards.

Why Contract Management Will Grow Your Business | Parley Pro


If you carefully read the small print of your contracts with payers, you will be able to determine whether or not they contain phrases that give payers the authority to change the terms of your agreement without first alerting you, the provider. This is of the utmost importance in view of current happenings in which payers have started modifying provider agreements on their initiative.

Report on the essential clauses and specifics of payer contracts

It is vital to have a comprehensive understanding of every clause in the payer contracts in order to manage the relationships effectively. This includes, but is not limited to, the specific terms associated with the cancellation or renegotiation of the contract, as well as the various compensation rates and requirements.

You have the option of tagging all of this contract information within the program of your choosing, after which you can use reports to see how this information differs across your whole portfolio of agreements.

Set up a system to notify you of upcoming renegotiation and expiration dates

In the majority of cases, the terms of contracts with healthcare payers are heavily weighted in favor of the payer. When healthcare providers are made aware of renegotiation and termination dates, they are better able to prepare themselves to take action and evaluate whether or not to amend the terms of an agreement, as well as whether or not to continue working with the payer.

You can be confident that you will always be informed well in advance of any significant dates in your payer contracts by making use of the alerts and notifications that are provided by software that manages contracts. This will allow you to have peace of mind.

Whether you set alerts 30, 60, or 90 days in advance of important deadlines, you will have plenty of time to evaluate each agreement and make the necessary preparations for the subsequent stages. This is the case regardless of whether you set alerts for 30 days, 60 days, or 90 days (or any other period).

Negotiate more favorable agreements

Providers are able to gain greater insight into the substance of contracts as well as the performance of those contracts with the assistance of the reporting elements that were detailed above. You can use this information to negotiate with payers for better reimbursement rates, or you can use it to decide whether it would make more sense to look for alternative payers.

You will be able to renegotiate contracts and terms that are more beneficial for your organization if you develop solutions that are evidence-based and data-driven. This will put you in a stronger position.

Final Thoughts

When a healthcare provider has contracts with various commercial and government payers, it can be not easy to keep track of all the different terms and conditions. Nevertheless, with the aid of contract management software, you can better analyze your contract portfolio, identify the most crucial details, and take calculated steps to improve your company’s bottom line.