Managed Care Contracting

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Optimize every revenue stream for your organization’s long term stability

The reimbursement rates negotiated with managed care companies in your market are a crucial element to a healthy bottom line. Obtaining and maintaining profitable managed care contracts and managing those contracts on an ongoing basis is the proven method to maximize your patient revenue streams. Since 1996, Strategic Health Care’s Managed Care team has been successful in finalizing competitive contracts for providers throughout the country.

Our team will work with you to determine if your organization is well positioned with each payor and define the steps necessary to improve your payor relationships. You will benefit from working with a team of professionals who have 25+ years of experience contracting with managed care organizations as well as an established reputation of fairness and professionalism throughout the industry. You will benefit from who and what we know.

Our Managed Care Contracting team will:

Position

Clients with targeted, exclusive payor contacts by maximizing unique business leverages and showcasing specialized service capabilities

Manage

Client demographics and credentialing information required for initial and ongoing contracting

Complete Applications

Finalize paperwork and RFPs as required in the contract negotiation process

Provide Language & Rate Review

Assess proposed or existing payor contract rates and language for beneficial business related revisions and negotiations

Negotiate

With managed care plan to achieve favorable language and rates on behalf of client

Facilitate

Facilitate execution and distribution of mutually agreed upon payor contract

Assist with Contract Installation

In-service education with client staff and payors to assure successful administration of contract and increase referrals

Advise

Advise client on business protocols for working effectively with contracted payors and the development of alternative payment models

Address

Address contract related issues including authorization, claims, and dispute resolution

Update On Compliance

Update client regarding Information on payor products and processes critical to compliance

Provide Ongoing Monitoring

Provide ongoing monitoring of the contract rates, terms and conditions for adjustments or renewals as necessary to benefit the client

Credentialing

Credentialing is also a major part of both the contracting division and the network development team. SHC offers a complete menu of credentialing services to all managed care providers including hospitals, SNFs, physicians/clinicians, ASCs, psych hospitals, skilled nursing facilities and all ancillary providers.

Credentialing services include:

Physician Clinician Credentialing
Commercial Insurance Credentialing
Government Payer Credentialing
Workers Compensation Credentialing
Medicaid Applications
Individual Medicare Enrollment Evaluation
Medical License Application Processing & Tracking NPI Registration (Type I & Type II)
Collection of All Documents/ Information, From Providers, Necessary to Complete Payor Applications
Management of the Credentialing Database Established for Each Client

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