Payor and managed care contracting services
We renegotiate your reimbursement rates, negotiate network participation with the payors your patients use, including ones that say they’re closed, and check that new rates are paid as signed. Payor contract negotiation for practices, hospitals and ancillary providers in all 50 states since 1994.
Founded in 1994 as Healthcents, PayrHealth since 2021.
The payor contracting cycle
Revenue cycle management has a map everyone follows. Payor contracting never had one. This is ours: six stages, run in order and repeated at every renewal. Each draws on three layers: market data, the precedent of tens of thousands of contracts and interactions, and the people at the table.
What our insurance contract negotiation services cover
Our payor contracting services cover higher rates on the contracts you have, new contracts where the lives are, and the part of every contract that never reaches the bank.
Mississippi Urology Outpatient Surgery Center: an 80% rate improvement worth $235,675 in its first year. Read the case study
Precision Medical Products: 3 contracts with payors that had called their networks closed, and 6M+ new lives. Read the case study
Integrated Respiratory Solutions: 659,369 covered lives reached through new Missouri network access. Read the case study
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.
The first year, month by month
The cycle above, run for the first time, counted from kickoff. Reporting runs alongside every phase, so you can see where each payor stands.
Client results
increase on select high-volume outpatient services over 3 years
rate increase on its payor contracts, with 10 new contracts secured
in reimbursement increases across its top five renegotiated payor contracts
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
Physician groups
Independent practices and specialty groups, including urology, ophthalmology and retina, orthopedics and behavioral health
Ancillary providers
DME suppliers, imaging centers and surgery centers
Private equity
Payor contract diligence and rate growth for portfolio companies
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
Payor contracting questions
What does a free rate review include?
We benchmark each of your payor contracts, using payor price transparency data, against what the best-paid quarter of practices like yours are paid for the same codes in your market, and show which contracts could pay more. Not every gap can be closed, since some of it reflects leverage, and the review shows you which is which. It’s free, with no obligation.
How long does payor contracting take?
It varies by payor. Negotiations usually begin about a month after kickoff, and new rates and contracts typically take effect 8 to 12 months in, once contracts are signed and credentialing is done.
What if a payor says its network is closed?
Closed often means closed to new applicants on standard terms. We build the case a payor needs to make room, such as gaps in its network, members you’re already turning away, or a service others in your area don’t offer, and take it past the first no.
Which contract terms do you negotiate besides rates?
The language can matter as much as the fee schedule. We negotiate terms such as overpayment recoupment limits, prior authorization protections, timely filing windows, a payor’s right to amend the contract on its own, and contract length.
Do you handle credentialing too?
Yes. When a new practice opens, or a contract needs new providers or locations credentialed, we coordinate credentialing with the payor so the contract can start on its target date. Credentialing is also available on its own.
What does payor contracting cost?
It depends on scope: how many payors and contracts, and what we're negotiating. Engagements are priced as a fixed fee for a defined scope, a monthly fee for ongoing contract management, a performance fee tied to the increase we negotiate, or a value share of the added revenue the new contracts bring in. After a first call we send a quote, and the client services agreement sets out pricing and scope before work starts.
Should we outsource payor contracting or keep it in-house?
Keep it in-house if someone on your team negotiates with payors regularly, knows current market rates for your codes, and has time for a process that runs 8 to 12 months. Most practices don’t have that person, and payors negotiate every day. Outsourcing brings market data, payor contacts, and someone whose only job is to keep the negotiation moving.
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.
After you submit, practices that qualify pick a time with our team on the next screen.
