Insurance payer agreements may establish participation terms, reimbursement arrangements, and other contractual requirements for healthcare providers and organizations.
Intelix Credentialing provides contract negotiation support to help practices review existing payer agreements and reimbursement information, evaluate potential opportunities for renegotiation, and coordinate applicable payer communications.
Negotiation opportunities and outcomes vary by payer, contract, market, provider, and practice circumstances.
Insurance contract negotiation involves evaluating and discussing applicable participation and reimbursement terms between a healthcare provider or organization and an insurance payer.
A review may involve existing contractual terms, reimbursement information, network participation arrangements, and the provider or practice's circumstances.
Intelix Credentialing can review available payer contracts and reimbursement information to help determine whether pursuing renegotiation may be appropriate.
Where applicable within the engagement, available reimbursement information may be considered against relevant market information as part of the review.
Evaluate the available payer agreement and reimbursement information.
Identify provisions or reimbursement arrangements that may warrant further discussion.
Organize relevant information for the requested payer discussion.
Support applicable negotiation communications according to the selected scope.
Track payer responses and outstanding matters.
The processes may interact, but they should not be described as identical.
Credentialing generally addresses professional qualifications.
Payer enrollment addresses provider or organizational participation and billing information.
Contracting establishes applicable participation terms and reimbursement arrangements.
