Contract Review, Fee Negotiation & Credentialing

Working with insurance companies is essential for maximizing revenue but it can be complex. Providers want to provide the most comprehensive care for their patients while earning a living and payers want to control healthcare costs in order to provide their consumers with competitive plans. Navigating this relationship requires dedicated time, strong analytics, and organized processes.  Let Lighthouse Healthcare Advisors help you through these complicated processes.

Contract Review & Fee Negotiation

It is important for healthcare organizations to perform periodic reviews of payer contracts to ensure providers are receiving optimal reimbursement for their services and to consider taking advantage of alternative payment models.  The terms of your payer contracts should support your mission and goals while ensuring optimized rates.

 

Lighthouse Healthcare Advisors has extensive expertise in the analysis of payer fee schedules and the detailed review of payer contract language.  Armed with this powerful information, LHA can assist you with successful contract negotiations and prevent you from getting stuck in an unfavorable contract.

 

LHA Contract Review & Fee Negotiation Services:

•        Comprehensive contract review.

•        Contract language analysis to ensure optimal terms for providers.

•        Utilization and payment analysis by payer to compare reimbursements.

•        Identification of strengths, weaknesses, and improvement opportunities.

•        Identification of threats of unsatisfactory payer contracts.

•        Preparation of competitive fee schedule analysis to support optimal rates.

•        Market Analysis to present comprehensive proposal to payers

•        Negotiation with payers to raise reimbursement rates.

Provider / Payer Credentialing

Credentialing providers is a time consuming, tedious necessity that can be costly if not done correctly. Facilities have many payers, including Medicare and Medicaid, each requiring a separate application and unique process for provider enrollment. It is essential for providers to get credentialed as quickly as possible to prevent delays in cash flow and minimize patient access issues.  Errors during the credentialing process can postpone a new provider's start date or prevent reimbursement for services.

 

Lighthouse Healthcare Advisors will take the frustration out of credentialing by handling the application process and enrollment maintenance for you.

 

LHA Credentialing Services include:

•        Collection and management of provider data.

•        CAQH registration and maintenance.

•        NPI registration

•        Requesting provider enrollment with payers to be approved as an "in network" or participating provider.

•        Gathering and submission of education, training and license verification.

•        Submission of other requested documents specific to the payer.

•        Completion of applications for each payer.

•        Follow up with payers on application status for timely enrollment.

•        Regular maintenance of payer credentialing requirement and changes.

Contact us for more information on what Lighthouse Healthcare Advisors can do for you!

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