CONTRACTING SERVICES

Strategic Alliance Systems & Revenue Recovery Relief™

Strategic Alliance System™ is customized program for increasing your overall contract revenue production. Our Senior Consultants have worked for major health plans and medical groups and understand all financial models used in managed health care. Our team will evaluate your existing contracts to determine if your rates are competitive and in alignment with the marketplace. You may be losing as much as $2.00 to $3.00 PMPM!

Strategic Alliance System™ is a cost-effective solution to ensuring that you are receiving the the maximum reimbursement available.

Tip:  Make sure your Agreements with Health Plans contain language-citing compliance with sections of the Health & Safety Code and Title 28, which outline the claims adjudication and dispute resolution provision. (AB 1455, Claims Settlement and Provider Dispute Resolution/ AB 2907, Provider Bill of Rights).

Strategic Alliance System™

Review of Contract - Rewrite of Contract: - Negotiation - Incentives

• Help fill your need for immediate marketing responses.
• Provide one-time project or ongoing program design and implementation.
• Stretch your marketing staff and budget to survive in the highly competitive healthcare environment!

Step 1: Review of Existing Contracts

To identify the terms and conditions as well as definitions contained in a contract that will substantially limit the provider's ability to overturn a denied claim.

• Review of existing contracts and rates.
• Review of contract language.
• Create spreadsheets of contract essentials, including last review date and terms.
• Evaluation of revenue streams and revenue producing potential.

Step 2: Contacting Strategy Development & Language

To develop model language that can be used to transform the provider's contract from an impediment to payment to a stimulus for fair, reasonable and predictable reimbursement.

• Gather intelligence on marketplace rates.
• Create comparison of rates to determine inconsistencies/gaps.
• Prepare contracting strategies to increase reimbursements in accordance with the marketplace.
• Develop implementation plan of action

Step 3:  Contract Negotiations

To participate as a member of provider's Managed Care negotiating team; conduct market research to ensure that contract rates are compatible with marketplace.

• Contact targeted health plans and IPAs to begin negotiations
• Re-negotiate agreements with rates below marketplace.
• Advise clients of disposition and exhaust all possibilities.

Step 4: Pay for Performance Incentives

• Evaluate health plan reports and revenue payments under Pay for Performance guidelines.
• Prepare report on missed financial opportunities under Pay for Performance based on an annual review.
• Prepare strategies to meet encounter data submission benchmarks to increase financial incentives.
• Follow up with submission of encounter data through data clearing house (Diversified Data Design - DDD)

REVENUE RECOVERY RELIEF™ "INSIDER INDUSTRY SECRETS"
HMOS – PPOS – MEDICAID (MEDI-CAL) - MEDICARE

Proactive Patient Services understands the many challenges you face as a healthcare provider. If you are a physician in private practice, a large IPA/Medical Group or hospital, we know that it is difficult to negotiate and receive the revenue you are due and owed! That’s why we offer solutions for contracting with health plans, IPAs and in collecting revenues due and owed.

Proactive Patient Services Contracting and Revenue Recovery Relief™ programs will help you optimize and manage your cash flow for improved revenue and profitability.

Revenue Recovery Relief™ offers targeted revenue recovery solutions that ensure accurate claims reimbursement, improved collections and cash flow.

Strategic Alliance Systems contracting services offers contracts analysis, market rate contract negotiations, contract “extras,” and contract compliance.

Most physicians have limited time and experience to deal with the complexity and bureaucracy of healthcare contracting and reimbursement. Contracting with health insurance managed care plans requires market intelligence, contracting knowledge and most importantly persistence!

Learn about:
Legal Tactics, Tips, and Techniques to Influence Insurers to Properly Pay for Services Delivered”

• Tactics for receiving timely payment of your claims.
• Legal remedies for stopping unfair payment practices.
• Tips for dealing with requests for unnecessary billing information.
• Information on untimely payments and refusals to pay interest.

Learn how you can:
Gain Greater Control of Your Practice’s Bottom Line

• Legislative codes, forms, and letters to secure timely payment of claims
• How to receive interest on late payments
• How to legally refuse sending unnecessary patient information
• What to do when underpaid or denied payment
• How to set your practice’s precedent to receive timely reimbursement

Find out how our Revenue Recovery Relief Program can help you capture revenue due and owed!

  Call:  562.924.7072