All healthcare plans are required to comply with a strict set of regulatory guidelines when looking to expand their services into a new area. This includes provider and facility specialties that are required to be provided within number, time, and distance standards set by the Centers for Medicare and Medicaid Services (CMS).
This means that anyone looking to expand into a new area, whether an entire state or simply the next county over, needs to identify and secure dozens of contracts with healthcare providers to guarantee eligibility for offering health plans in that area. This is where network development comes in. Few organizations are equipped to handle the task of identifying providers, negotiating and securing contracts, and analyzing data to ensure standards are met all before individual, non-standard deadlines pass.
Missing even a single benchmark when looking to expand means lost work and money, not to mention the opportunity cost of millions of dollars in revenue. Outsourced network development with PayrHealth means the entire process of expanding into new markets and states is handled by full-time experts with access to the latest data to get the process right the first time, while saving insurers the headache of handling this in-house.
Any organization looking into expanding healthcare plans into a new market can benefit from managed network development. When a health plan enters a new territory it generates millions of dollars in new revenue. Network development costs a fraction of that and gets guaranteed results within a year of implementing a strategy.
The timeline for new market expansion varies, as certain applications are only available once every few years. That’s why identifying every necessary provider and specialty contract opportunity before jumping into the negotiation and credentialing phase is vital; it ensures you don’t waste time applying for a region you won’t get this year anyway.
Health insurance organizations offering coordinated care plans (CCPs), Medicare Advantage (MA) plans, network-based private fee-for-service plans, and network-based medical savings account plans are among those who are under regulation for managed care contracting.
PayrHealth is an all-in-one payor relationship management solution. We strategically and proactively manage contracts, payor relationships, and revenue cycles to help level the playing field between independent providers and payors.
Meet with a team that understands your unique needs wherever you are.
Our team covers and have solved problems in a wide-ranging variety of provider industries.
We’re a growing company, too! We focus on your growth and aim to be a dependable partner for years to come.
Our team is uniquely structured to help insurers grow and scale by entering new markets with competitive contracts. We help organizations close more than a contract a day on average with our highly experienced team of contract negotiators, who have closed over 50,000 deals in all 50 states.
The critical first step to ensuring you’re making the right moves at the right time is analyzing the environment you want to expand your offerings into. By identifying the available providers, their location, and analyzing the different requirements of different counties, we can ensure you’re on track to comply with every regulation that applies to your plan. This saves your organization time and money and guarantees you don’t spend time on a county you wouldn’t be able to get.
With experience in all 50 states, our team is well versed in the ever-changing national landscape of specialty providers. We identify a strategic set of providers in each territory that offer competitive contract options while carefully complying with network adequacy criteria.
PayrHealth leverages a constantly evolving data set to identify ideal providers for the most efficient and quickest path to applying for new market acquisitions.
Expansion of any kind is beneficial, but expanding with competitive rates and contracts is the best way to do it. With access to real-time benchmarks for every territory, we’re able to advocate on your behalf as an informed negotiator. Not only does this mean our experts help seal optimal contracts, it also means you don’t have to spend any time contacting providers, re-contacting them, and finalizing deals.
If market expansion seems like a huge undertaking, that’s because in most cases, it is. With 45-65 necessary provider types required per county, even just moving into the next nearest population center can be a huge headache for an inexperienced in-house team. The simple truth is that outsourcing this work to expert health insurance contracting consultants is a faster and cheaper way to start generating more revenue.
If you’re interested in how network development could help your organization make millions of dollars more each year, take the first step by contacting PayrHealth today. We’re happy to be your partner in scaling and growing your business in the long term.