The client’s needs were within their DME division, requiring PayrHealth’s expertise in RCM, payor contracting and credentialing. From an RCM perspective, the client needed support increasing their cash flow from payor claim submissions and improving workflow efficiencies to expedite collection of payment. The client was also seeking support with contract negotiations, maintaining payor relationships, obtaining contracts with new payors and guidance for compliance with Medicare and Medicaid participation.
PayrHealth’s goals for the client were to increase their cash flow, evaluate payor contracts and identify new networks for participation. The payor contracting team was able to successfully maintain the client’s in-network status with UHC and BCBS of Nebraska with marginal negative impact to rates, after the client received a termination letter due to payor network narrowing. PayrHealth successfully reinstated the client’s PTAN with Medicare in an expedited timeframe to avoid any lag in the client’s claim reimbursement. PayrHealth also re-credentialed various locations that had fallen non-compliant, which salvaged the client’s in-network status with Tricare, BCBS, and WellCare. The team has also executed new contracts with Medica and Molina and renegotiated an existing contract with Full-Service Healthcare Provider agreement.
After partnering with PayrHealth, the client has expanded their patient volume pool and is now seeing higher reimbursement rates. The result is an overall more positive and sustainable relationship with their payor-partners and a better understanding of the contracting process. The client is now confident they can continue to provide quality care and be fairly reimbursed for many years to come.
Having negotiated over 50,000 contracts in all 50 states, PayrHealth has the knowledge and expertise to secure highly competitive rates and terms for your contracts, no matter how outdated they are or how big a player the payor is.