Payor Contracting

Ways to Improve Efficiency in Payor Contract Management

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Contract management within the healthcare field is a complicated process.

Working out and understanding the payor contracting and contract terms with insurance companies can be costly and time-consuming. Not to mention, they can be filled with small details that are easy to miss in the payor contracting process. Nonetheless, it’s vital work that every healthcare facility and practice must go through.

To make this process easier, you can employ a few techniques to streamline things.  If you’re looking to improve payor contract management efficiency, here are some important steps to take.

Utilize Technology

In today’s modern world, nearly everything is made more efficient by increasing technological advancements—and healthcare is no exception. Using technology as a vehicle for payor contract management can help speed up the process and ensure that changes are being implemented with greater ease.

Update the System

Want to maximize efficiency? Then your contract management systems must be up-to-date, meaning any changes made to the contract between you and your payor should be logged as soon as possible. Examples of these changes include:

  • Rate adjustments – If the rate you pay is subject to any changes that stray from the original contract, these adjustments must be immediately reflected in the payor’s system. Carefully watch your payments to make sure the new rate has been implemented and that you’re not paying too much or too little. If you notice you’re paying the same rate as before, then the payor may not have updated their system. Alert the payor of this issue as soon as possible to avoid further confusion and loss of efficiency.
  • Reimbursements – Ideally, your software should be able to calculate reimbursement rates automatically. This saves time and minimizes the workload for your management team. The most efficient payors will have technology that provides customized reimbursement calculators. These calculators can help reduce the time it takes to determine each person’s rates. It can also decrease the total number of variables within the calculation. With so much data to work with, having updated and accurate technology can save you a lot of time and energy during this process and allow you to focus on implementing your contract negotiation strategies.
  • Added or subtracted benefits – Changes to the benefits within your payor agreements should also be factored into the payor’s software immediately. If your rates are being adjusted due to your package changes, then the added or subtracted benefits should also be reflected in the same amount of time. Having software that keeps all this vital information easily accessible will boost efficiency and reduce confusion surrounding your healthcare services.
  • New patients – A newly covered patient should also be immediately included in the contract management system. Doing this digitally will empower patients, allowing them more access to their benefits.

Using software that automatically puts these updates into action is an essential step in achieving optimal efficiency.

Improve Communication

Technology also makes it possible to streamline communication between you and your payor.

Keeping everyone up to date, even after an in-person contract negotiation has wrapped, is a simple way you can maximize efficiency in payor contract management. It’s vital that all information is stored in an easily accessible online portal. Doing so prevents confusion by ensuring that everyone is on the same page.

Critical information about payor contracts should include

  • Services covered – You’ll want to provide a detailed list of the current plan’s services. This information clues patients in on what to expect from their billing statement and makes it straightforward for the payor what’s required from them.
  • Reimbursement rates and copays – Communicating reimbursement rates and copay costs to those covered by the payor will reduce confusion and help individuals better prepare for future bills.
  • Claim periods – It’s possible to increase overall efficiency by providing clear information about the window of time in which the provider has to file a claim. Miscommunication about claim periods will not only slow down the entire process, but also potentially result in unnecessary costs.
  • Due dates – Most importantly, be sure to highlight critical due dates to your payor. Knowing when the time has come for contract renewals, negotiations, and terminations can help schedule and streamline the process.

The biggest enemy of efficiency often comes down to a lack of communication. A miscommunication about benefits offered or reimbursement deadlines could result in additional costs and headaches for both parties.

Don’t Skimp on Training

Contract management tools require extensive training in order to be implemented into your practice. An excellent way to ensure operations run smoothly is to invest the time necessary to teach staff the ins and outs of whatever software you’re using. In doing so, you will avoid mistakes and create a smooth transition between payments.

It’s crucial that your training is especially rigorous when it comes to:

  • Rate calculation – Determining rates involves a lot of data and variables. A thorough training process is needed to ensure that calculations are accurate when it comes time to determine individual costs.
  • Filing – Organizing all this information will require a proper filing system. To minimize the time spent searching for information, make sure to perform a detailed software review with your staff.
  • Problem solving – Another way to boost your contract management staff’s efficiency is by running through troubleshooting exercises. If your team knows how to solve fundamental problems that may arise within the system, you can reduce the time and money spent on technical support. Creating a more self-sufficient work environment pays dividends in the long run.

Consistent Monitoring

Once contracts are signed and employees have been trained, the work doesn’t end there.

If you want to continue managing your payor contract efficiently, you’ll need to be diligent with maintenance and monitoring. Proper monitoring of your contract will require:

  • Watching out for payment variances
  • Making sure payments are made on time
  • Double checking calculations for accuracy
  • Ensuring there are no data errors
  • Observing market changes and annual performance

Don’t let your guard down. Doing so could hamper the overall efficiency of your payor contract management system. Additionally, you must continue to utilize management techniques throughout the remainder of your contract period. Any errors or missed payments could result in lost time and money, which will not do your efficiency metrics any favors.

Use a Contract Manager

The easiest way to optimize is by outsourcing some of these tasks to a third-party company specializing in payor contract management. payor contract consultants focus on the details so you don’t miss anything important.

A payor contract manager is going to boost efficiency in several different ways.

  • Improved payor contract negotiation – A contract manager knows the right questions to ask, what rates you should shoot for, and how to handle the insurance companies (payors). Going into contract negotiations unprepared is a surefire way to leave dissatisfied, so don’t be afraid to enlist help. A contract manager will speed up the process with their knowledge and experience, ensure you get a better contract, and reduce time spent negotiating.
  • Advisement – You may be confused about what exactly you require from your relationship with the payor. A contract manager can help you decide which elements of your existing contract are necessary and which aren’t. From EHR software to hands-on services and benefits packages, everything you need to know can be explained with a professional’s greater expertise. While you may not specialize in managing payor contracts, that shouldn’t stop you from hiring someone who does.
  • Specialists – Speaking of specialization, a company that provides contract management support is also going to offer you a greater selection of specialists within specific fields. These specialists include legal experts, data analysts, contract negotiators, and more. If your practice has a small staff that lacks experts in any of these fields, a consulting company with their own team of specialists can help increase payor contract management efficiency.

PayrHealth: Your Modern Contract Manager

If you’re looking for a contract management company that specializes in healthcare, understands the importance of technology, and has the expertise you need for successful negotiations—look no further than PayrHealth.

PayrHealth assists healthcare facilities and small practices in handling the hefty task of payor contract management. Insurance companies can be pricey and time-consuming, and negotiating contracts with them can leave healthcare professionals exhausted and confused.

At PayrHealth, we can help you:

  • Contract analysis to help you sign better contracts that fit your unique offerings, service, area, and strategy
  • Negotiate higher rates, putting you in the best position for increased reimbursement
  • Supplement or expand your team by outsourcing our experts

Don’t get pushed around during negotiations. PayrHealth can help you make the decisions that are right for your practice. PayrHealth will make payor contract management more efficient and less stressful. We offer an unbiased opinion, years of experience, and a full team of specialists who are ready to work for you and with you.  

In other words, we’re an extension of your team. Ensure you have time to do the work you love, and leave the contract management to the experts.


RevenueMasters. Operational Efficiency in Healthcare Contract Management.

Optum360. Five Critical Evaluation Factors for a Contract Management and Modeling Solution.

HFMA. Managing and Measuring payor Performance.

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