Revenue Optimization

Payer Contract Negotiation Services

Expert payer contract negotiation and fee schedule analysis services. Maximize your reimbursement rates with Medicare, Medicaid, and commercial payers through strategic contract review and negotiation.

500+ Contracts Negotiated

15-30% Avg Rate Increase

50+ Payers Covered

Start Contract Review Free Fee Schedule Analysis

Maximize Reimbursement

Expert Contract Negotiation

Commercial, Medicare Advantage, and managed care contracts

Our Process

Contract Negotiation Made Strategic

Our data-driven 3-step process maximizes your reimbursement rates and contract terms.

Fee Schedule Analysis & Benchmarking

We analyze your current fee schedules against Medicare rates and market benchmarks to identify opportunities.

Strategic Negotiation

We engage payer representatives with data-backed proposals to secure higher reimbursement rates.

Contract Review & Execution

We review contract terms, ensure negotiated rates are reflected, and guide you through execution.

Contract Types We Negotiate

All Payer Contract Types

We negotiate and review all types of payer contracts and agreements.

Commercial Payer Contracts

Aetna, BCBS, Cigna, Humana, UHC and more

Medicare Advantage Contracts

All major Medicare Advantage plans

Medicaid Managed Care

State Medicaid MCO contracts

Self-Funded/ASO Plans

Employer self-funded plan agreements

Marketplace Plans

ACA Exchange plan contracts

Workers' Compensation

WC network and fee schedule agreements

IPA & PHO Agreements

Independent practice association contracts

Value-Based Contracts

Shared savings and quality incentive agreements

Contract Elements

What We Negotiate & Review

We focus on key contract elements that impact your revenue and practice operations.

Fee Schedules

CPT code reimbursement rates and percentage of Medicare

Annual Increases

Built-in fee schedule escalators and inflation adjustments

Timely Filing Limits

Extended claim submission deadlines

Termination Clauses

Without-cause termination notice periods

Dispute Resolution

Appeals and arbitration processes

Payment Terms

Prompt pay requirements and interest on late payments

Credentialing Timelines

Expedited credentialing requirements

Amendment Rights

Unilateral amendment restrictions

Indemnification

Liability and hold harmless provisions

Non-Compete Clauses

Restrictive covenant review and negotiation

Quality Incentives

Pay-for-performance and shared savings opportunities

Telehealth Coverage

Virtual visit reimbursement parity

Fee Schedule Analysis

Data-Driven Rate Benchmarking

We analyze your current rates against market benchmarks to identify negotiation opportunities.

Medicare Rate Comparison

Analysis of commercial rates vs Medicare allowable amounts

Geographic Benchmarking

Regional and local market rate comparisons

Specialty-Specific Analysis

Benchmarking against similar specialties in your market

Top CPT Code Analysis

Review of your most frequently billed codes

Revenue Impact Projection

Financial modeling of proposed rate increases

Historical Rate Trends

Analysis of past rate changes and inflation impact

Payer Comparison Matrix

Side-by-side comparison of all payer fee schedules

Negotiation Target Setting

Strategic rate targets based on market data

Why Choose Us

Contract Negotiation Excellence

We bring expertise and data-driven strategy to every negotiation.

Data-Driven Approach

We use market data and benchmarks to build compelling cases for rate increases.

Payer Relationship Expertise

We understand payer priorities and how to effectively negotiate with each organization.

Comprehensive Contract Review

Beyond rates, we review all contract terms that impact your practice operations.

Proven Results

Average 15-30% reimbursement increases for our clients across all specialties.

FAQ

Contract Negotiation Questions Answered

Clear answers to common questions about payer contract negotiation.

When can I negotiate my payer contracts?

Most contracts can be renegotiated upon renewal (typically every 1-3 years). Some payers allow mid-cycle renegotiation with significant practice changes.

How much can you increase my reimbursement rates?

Average increases range from 15-30% depending on current rates, specialty, market conditions, and payer. We provide projections before engagement.

Do you work on contingency or flat fee?

We offer both contingency-based (percentage of increased revenue) and flat-fee arrangements depending on the scope of services.

Can you negotiate with Medicare?

Medicare fee schedules are set by CMS and cannot be negotiated. We focus on Medicare Advantage and commercial payer contracts.

What if a payer won't negotiate?

Some payers have fixed fee schedules. We identify alternative opportunities like quality incentives or expedited credentialing.

How long does contract negotiation take?

Negotiations typically take 60-120 days from initial analysis to executed amendment or new contract.

Do you review contracts before I sign?

Yes, we provide comprehensive contract review services to identify unfavorable terms before you commit.

What specialties do you work with?

We work with all specialties including primary care, surgical specialties, hospital-based physicians, and behavioral health.

Can you help with out-of-network negotiation?

Yes, we can negotiate single-case agreements and out-of-network rates for specific patient situations.

Do I need an attorney for contract review?

We provide business and operational review. We recommend legal counsel for complex legal terms and liability provisions.

Ready to Maximize Your Reimbursement?

Let our contract negotiation experts analyze your fee schedules and secure higher rates from your payer contracts.

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