$1M ROI
from a single renegotiated agreement
Higher Rates
across multiple business lines
Securing Fair Reimbursement and Driving $1M in ROI
About the Client
This provider has been delivering high-quality applied behavior analysis (ABA) therapy for nearly two decades, helping children and young adults with autism and developmental disorders reach their full potential. With nearly 30 locations across more than 10 states, they offer individualized, evidence-based care for patients from infancy through early adulthood.
The Challenge
Despite a strong clinical reputation and wide-ranging service model, the organization faced serious challenges in its payor contracts, including:
- Reimbursement rates that didn’t reflect the full value or complexity of services delivered
- Inappropriate rate benchmarking by payors, comparing their services to narrower, less comprehensive ABA programs
- Repeated denials from payors when requesting improved terms
They needed a strategic partner to help them secure contracts that aligned with the scope and impact of their care.
PayrHealth’s Solution
The organization engaged PayrHealth to lead a targeted renegotiation strategy using market insights, proven advocacy, and long-standing payor relationships.
Key Tactics Included:
- Strategic Renegotiation: Worked with three large payors, including plans with both commercial and Medicaid lines of business
- Tailored Advocacy: Highlighted the client's unique ability to serve patients ages 0–25, a broader range than many competitors
- Data-Driven Benchmarking: Leveraged robust market data to define and support fair reimbursement targets
Results
- Successfully renegotiated contracts with three major national payors
- Secured higher rates across multiple business lines
- Achieved a $1M ROI from a single renegotiated agreement
After years of stalled internal negotiations, this partnership with PayrHealth led to meaningful financial improvements and expanded access to care.
Contact PayrHealth
Having negotiated over 50,000 contracts in all 50 states, PayrHealth has the knowledge and expertise to secure highly competitive rates and terms for your contracts, no matter how outdated they are or how big a player the payor is. We also have a team with over 40 years of experience in management of revenue cycles and helping you close down on lost revenue through your practice. Contact us today to learn more.
