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  • Providers: Take Back Power During Payer Contract Negotiations

    Covering reimbursement rates, medical necessity, credentialing, and prior authorization (PA), payer-provider contracts are key to emergency medicine (EM) providers getting paid both accurately and on time

    Providers: Take Back Power During Payer Contract Negotiations Covering reimbursement rates, medical necessity, credentialing, and prior authorization (PA), payer-provider contracts are key to emergency medicine (EM) providers getting paid both accurately and on time. However, providers are often left in the dark as to whether or not these contracts are favorable to them. Until recently, providers have been unable to see the same data that payers use to create leverage during these negotiations, such as insight into competitors, market rates, and more.

    Now, providers can access actual claims data through healthcare market intelligence services, a gamechanger that has put power back into providers’ hands. By utilizing adjudicated claim and remit data on charges, payments, denials, and more, providers can better prepare for these negotiations. They can evaluate their own services and determine what their differentiators are — all with insight into how their competitors for same or similar services measure up.

    To help them negotiate successfully, providers should consider investing in a best-in-class healthcare data service. Capabilities to look for include, but are not limited to:
    • Allowing providers to see actual reimbursement rates from payers within a user-defined region and specialty
    • Enabling filtering by taxonomy
    • Eliminating “ghost rates”
    • Offering visibility into payer behavior, such as denial rate by code, and total payment trend by payer and code
    • Compliantly revealing market competition charges and payment rates

    To learn more about the value of healthcare claims data, read the full article, “Healthcare Claims Data Helps EM Providers Restore Good Faith in Payer Contract Negotiations.”


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    Gain More Confidence and a Stronger Position During Open Negotiations and IDR 

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