About the Client

Integrated Respiratory Solutions is a durable medical equipment provider based in Carol Stream, Illinois, with additional locations in Westmont, Illinois and Eureka, Missouri. The company focuses on pediatric respiratory services, which require specialized equipment, clinical expertise, and ongoing respiratory management that general DME providers are not equipped to deliver, and on specialized adult respiratory services for patients with ALS and end-of-life needs.

Client Need

• Network access in Missouri, a new agreement from a baseline of no contract
• Revenue loss while patients in the region remained out of reach
• DME networks frequently closed to new providers, requiring the specialty case to
  be made directly

The provider had no contract with the region’s largest commercial payor and was losing revenue to a lack of patient access in Missouri.

PayrHealth's Solution

PayrHealth handled payor contracting and supporting analytics, working the request
through to approval:

Specialty value proposition. Built a detailed summary of the provider’s specialized services and a written value proposition statement for payors.

Reconsideration requests. Submitted requests for reconsideration on initial denials, restating the clinical case for network need.

Payor escalation. Asked payors to escalate the request to leadership for further evaluation where standard review closed the door.

Key Takeaway:

A DME provider facing closed networks secured a new Missouri commercial agreement by documenting its respiratory specialization, reaching 659,369 covered lives in a region where it previously had none.