PAYER CONTRACT NEGOTIATION
Many practices operate on payer contracts that haven’t been reviewed in years. Elara Associates analyzes your agreements, compares reimbursement against market benchmarks and your costs, and supports renegotiation with the data payers expect to see.
Billing data and contract analysis in one place
Measured, realistic recommendations
THE PROBLEM
Operating costs rise every year. Payer contracts often don’t. Without periodic review, a practice may be accepting reimbursement that no longer reflects the cost or value of its care.
Common issues we see:
THE SOLUTION
Payers respond to organized, specific requests supported by data. We prepare that case for you.
Our team reviews each contract’s rates and terms, compares reimbursement for your highest-volume codes against available benchmarks, and models the financial impact of proposed changes. We then help you prioritize which payers to approach, prepare the proposal, and manage follow-up communication. We negotiate directly on your practice’s behalf.
Because we also manage billing, we can compare what your contracts say against what payers actually pay, which is often where the first recoverable dollars appear.
SERVICES INCLUDED
01
Inventory of all active payer contracts, amendments, and fee schedules
02
Contract term review (timely filing, appeals, recoupments, termination, renewal)
03
Reimbursement analysis for high-volume CPT codes
04
Market benchmarking
05
Payment variance analysis (contracted vs. paid amounts)
06
Underpayment identification and recovery support
07
Payer prioritization based on volume and opportunity
08
Renegotiation proposal preparation
09
Payer communication and follow-up support
10
New payer contract evaluation
11
Contract renewal calendar and tracking
12
Referral to legal counsel for contract language review
BENEFITS
And how it compares to your costs.
Where payers pay less than contracted rates.
Built on your own claims data.
Beyond rates, such as filing limits and appeal windows.
With a calendar that tracks every contract.
For marketing and growth planning.
OUR PROCESS
01
We gather contracts, amendments, fee schedules, and 12 months of claims and payment data.
02
We review terms, calculate reimbursement by code and payer, identify payment variances, and compare rates against benchmarks.
03
You receive a report ranking payers by financial opportunity and outlining recommended actions.
04
We prepare renegotiation proposals and support outreach to payer representatives.
05
We track payer responses, and once new terms are agreed, update fee schedules in your billing system so payments can be monitored for accuracy.
06
Payments are checked against contracted rates, and renewal dates are tracked for future reviews.
FREE REVENUE REVIEW
Request a contract review and we’ll show you where reimbursement, payment accuracy, or contract terms may be costing your practice.
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WHY CHOOSE ELARA ASSOCIATES
so variances surface quickly.
based on your market and leverage.
which is often the right time to set terms with a new payer.
so campaigns focus on patients whose coverage supports your practice.
and a dedicated point of contact.
FAQ
Still have questions? Talk with our team.
Many practices review major contracts annually and before each renewal date. Reviews are also useful after adding services, providers, or locations.
Results vary, but smaller practices can still make well-supported requests, especially when they offer specialized services, strong quality data, or serve areas with limited access to care.
Your current contracts and amendments, fee schedules, and recent claims and payment data. We provide a checklist and a secure way to share files.
No. Payers make their own decisions. We focus on identifying opportunities, preparing a strong case, and recovering payments that don’t match your contracts.
Elara Associates provides business and financial analysis. For legal interpretation of contract language, we recommend review by a qualified healthcare attorney.
Request a contract review and we’ll show you where reimbursement, payment accuracy, or contract terms may be costing your practice.
