Healthcare payor consultants

Payor contract negotiation services for practices, hospitals and ancillary providers

Since 1994 we have negotiated payor reimbursement rates and network participation for providers in all 50 states. A free rate review shows which of your contracts could pay more.

See if you qualify for a free rate reviewOr call (800) 497-4970
As seen inCNNBecker's HealthcareHFMA
Rate review

Where your contracts stand

Each contract against what the best-paid quarter of practices like yours are paid for the same codes, in your market. Example data

3 of 4 contracts pay you less than the best-paid quarter of your peers.

See if you qualify for a free rate review

Part of a gap is leverage you may not have; part is a contract nobody has renegotiated. A review tells them apart.

Example data. Peers are practices in your specialty and market, compared payor by payor and code by code; the top-quarter rate is a reference point, not an outcome.

1994
Founded
50,000+
Payor contracts handled by our team
9,000+
Payor contacts
All 50
States served

PayrHealth is a healthcare consulting firm specializing in payor contracting, founded in 1994 as Healthcents and renamed in 2021. We secure and negotiate payor contracts for specialty groups (including urology, ophthalmology and retina), ambulatory surgery centers (ASCs), community hospitals and health systems, and DME and ancillary providers in all 50 states.

Trusted by providers including

How we grow your revenue

Higher rates on the contracts you have, new contracts where the lives are, and the part of every contract that never reaches the bank.

Where to look first

Three contracts worth a call

Ranked by each payor’s share of commercial lives and the size of the gap to the best-paid quarter of your peers. Example data

  1. 1
    Payor B44% of commercial lives
    24% below the top quarter
  2. 2
    Payor U20% of commercial lives
    12% below the top quarter
  3. 3
    Payor C12% of commercial lives
    18% below the top quarter

Payor H has a bigger gap than Payor U but a tenth of the lives; Payor A is in the top quarter.

See if you qualify for a free rate review

Example data. Rank reflects the size of the gap, not what you can close; that depends on your leverage with each payor.

Mississippi Urology Outpatient Surgery Center: an 80% rate improvement worth $235,675 in its first year. Read the case study

Closed networks

When a network says it is closed

The play that opens it: who to go to, with what, and in what order. Example sequence

  1. Provider relationsSays the network is closed. Expected, and where most practices stop.
  2. Network managerThe access gap: lives in the area, drive times, wait times.
  3. Contracting directorThe business case: cost per episode, quality, referral patterns.
  4. Market VPThe clinical case, with the medical director where it helps, and a specific ask.
  5. ContractSigned, loaded and paying.

A closed network opens at the right level, with the right case, in the right order.

Ask about a network that said no

Example sequence. Levels and order vary by payor and market.

Precision Medical Products: 3 contracts with payors that had called their networks closed, and 6M+ new lives. Read the case study

New contracts

Get into new networks

Reach more of your market by signing the payors whose members live there. Example data

4payors in network, up from 4
38%of the market’s commercial lives reachable, up from 38%
Who holds the commercial lives in your market
Payor B 44%Payor U 20%Payor C 12%

Three new contracts put you in network for nearly twice the commercial lives in your market.

See which networks you can join

Example data. Your map starts from your contracts and the lives in your market.

Integrated Respiratory Solutions: 659,369 covered lives reached through new Missouri network access. Read the case study

Revenue cycle

What your contracts actually pay

For every $100 you are contracted to receive, how much reaches the bank, and where the rest goes. Example data

$12 of every $100 is lost or late, and $3 of it is payors paying less than the contract you negotiated.

At this example’s yield, $300,000 a year is lost or late, $75,000 of it from payors paying below contract.

Check your yield to cash

Example data. Each dollar lands in exactly one row: paid, still owed after 90 days, or lost to a denial, an underpayment or an unpaid patient balance. A yield check compares your remits with your contracts, claim by claim.

Priority Hospital Group: $330K recovered from claims underpaid under site-neutral payment policies. Read the case study

Credentialing and provider enrollment, kept current so new contracts start paying on time. Contract management after signing is part of complete payor management.

Client results

Hospital system
25%+

increase on select high-volume outpatient services over 3 years

Read the case study
Urology group
40%

rate increase on its payor contracts, with 10 new contracts secured

Read the case study
Fertility clinic
$257,000

in reimbursement increases across its top five renegotiated payor contracts

Read the case study

See all case studies

Who we work with

Payor contracting for provider organizations of every size, in all 50 states.

Hospitals and health systems

Community and independent hospitals and the systems they belong to

Surgery centers

Ambulatory surgery centers, from the first contract to the renegotiation

Physician groups

Independent practices and specialty groups, including urology, ophthalmology and retina, orthopedics and behavioral health

Ancillary providers

DME suppliers, labs, imaging, home health and other ancillary providers

Private equity-backed platforms: payor contract diligence and rate growth across the portfolio.

As seen in

What clients say

“They use rigorous data analysis as the basis for developing a solid negotiating approach.”

Leland Tong, MD · Google review

“We highly recommend their services to any healthcare provider looking to optimize their revenue.”

Dr. Rajesh Gupta, Medical Director, AFC of Yorktown

“They will take the time to help you figure out what you need and then work with you to achieve it.”

David Siegel · Google review

“They are very easy to work with and incredibly responsive when we have questions.”

Brandi Garlutzo · Google review

See where your rates stand

A free rate review benchmarks each of your payor contracts against the best-paid quarter of your peers, using payor price transparency data, and shows which gaps a negotiation could close. No obligation.

Contact

How can we help?

Schedule a free consultation and we’ll talk about how we can support your organization and its revenue goals.

PHONE:
800-497-4970EMAIL:
info@payrhealth.com

After you submit, practices that qualify pick a time with our team on the next screen.

(800) 497-4970 · info@payrhealth.com