Healthcare providers often view credentialing and contracting as separate administrative hurdles they must clear to start practicing. While these processes might seem distinct on the surface, they’re actually two sides of the same coin, both essential components of establishing a viable healthcare practice. Knowing why both are necessary, and how they work together, can save […]
Contract Management, Contract Negotiation, Credentialing and Contracting
Healthcare providers often believe they have limited options when it comes to improving their payer contracting income. This assumption couldn’t be further from the truth. Contract negotiation and contract management represent powerful tools your healthcare organization can leverage to enhance current contracts and increase revenue substantially. The challenge lies in execution. Many physicians struggle to […]
Contract Management, Payer Contract Negotiation, Payer Negotiation
Healthcare payers use six KPI categories to drive contract decisions: financial performance (MLR, PMPM), quality outcomes (HEDIS), network adequacy, member satisfaction (CAHPS), utilization management, and risk-based performance. Together these metrics determine reimbursement rates, preferred network status, and contract renewal terms. Selecting the right indicators requires balancing cost containment with care quality, too many payers track […]
Contract Management, Medical Loss Ratio, Payer Contract Negotiation, Payer Contracting, Value Based Care