After negotiations are complete, the focus shifts from strategy to execution and monitoring. Effective post-negotiation practices help ensure that contracts achieve their intended financial, operational, and quality objectives while maintaining strong payer relationships.
Executing the Contract
After all parties have signed, request and save a copy of the fully executed contract. If the effective date was not filled in before you signed, follow up with your contact to verify when the new terms will go into effect.
Ensuring Accurate Implementation and Ongoing Operations
After a contract goes into effect, practices should check that the operational, administrative, and financial components of the agreement are implemented correctly.
A helpful tip for ensuring accurate implementation and ongoing operations is to have initial and ongoing review of your contracts and processes as appropriate for your practice.
Comparing Payment Received with Contracted Rates
Once the agreement is effective, check payments across a variety of services to verify alignment with the contracted rate. If your contract includes escalators, schedule future reminders to verify that the changes to rates go into effect as specified.
Verifying Provider Directory and Credentialing Accuracy
Confirm that all clinicians, locations, and practice details appear correctly in the payer’s provider directory. Ensure that credentialing records reflect accurate effective dates and that none are mistakenly listed as closed to new patients or designated under the wrong specialty.
Operationalizing Contract Requirements
Review any new or updated operational requirements associated with the agreement, such as prior authorization processes, billing guidelines, documentation standards, coding rules, or reporting expectations. Share relevant updates with front‑office, billing, and clinical staff.
Monitoring Performance
Once the new rates have been in place for some time, evaluate performance by comparing actual payment to projections and identifying denial patterns, administrative issues, or payer policies, such as downcoding, that affect payment.
Planning for the Next Renegotiation
As with any relationship, it is important to maintain regular contact with your network management and provider representatives. Keeping active relationships can be helpful in case any questions or issues arise and for starting this process over when you are ready to renegotiate. In preparation, consider reviewing price transparency resource tools for data on negotiated commercial payment rates.
A tip is to begin reviewing your contract for renegotiation about a year in advance of the renewal or expiration date.
Along those lines, keep track of when the initial term is over and when you can renegotiate. Keep in mind that the process of renegotiating can take months, and you should start preparing before the initial term is over.
Takeaway
Managing your payer contracts is not a one-time event that ends once negotiations are complete. Effective payer contract management can position practices for ongoing success.
Disclaimer: This information is general in scope and educational in nature. It is not intended as financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.