SHP offers an array of managed care contracting services to meet your needs.
Specifically including project-based work and ongoing contract support. Details about the processes we take are below. Think of us as your outsourced managed care contractor.
- Prepare matrix of all existing agreements and reimbursement rates to determine average discounts given mco contract portfolio.
- SHP will review service lines in an attempt to include all components in the final agreement.
- We review claim dataset to identify top payers and the most impactful agreements.
- Review payer access to ensure discount given is commensurate with level of steerage.
- Prepare a detailed grid of terms to be addressed during negotiation and summary of top issues.
- Perform reimbursement analysis across the spectrum of payers and model against new contract offerings.
- Obtain data downloads for the last 12 months of claims.
- Analyze paid claims data by payer in order to determine percentage of Medicare allowed or other applicable base line.
- Summarize the data and compare the results to market rates.
Managed Care Processes
- Recommendations for contracting actions based upon data analysis, payer penetration and market knowledge.
- Request copies of current payer contracts and reimbursement rates.
- Perform audit of current and annual participation status in various payer plans.
- Recommend strategic contracting strategy.
- Negotiate contracts and reimbursement rates as defined by the contracting strategy and approved by Client.
- Prepare matrix of significant contract language.
Ongoing Contracting Support
Our ongoing support is intended to emulate the use of an internal managed care department for the health system. Typically, we maintain payer relationships and initiate any contracting discussions. The client can choose the degree of involvement. Typically SHP usually conducts payer negotiations directly with the payer, and then informs the client as to outcomes, recommendations, and next steps. After that, SHP typically maintains all current agreements and owns the process of validating contract performance and initiating negotiations/re-negotiations.