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4 tips for medical practices to negotiate contracts with pro payers 

Negotiating contracts with pro payers can seem like a complex process for medical practices. However, this process is critical to ensure reimbursement and maximize revenue for practices. 

The healthcare industry is constantly evolving, and pro-payer contract discussions are also rapidly changing. Improving negotiation skills is essential to get the best out of the contract and drive the best outcomes for practices.  

At Health Prime, we compiled four techniques you can implement to improve your payer negotiation skills:  

1. Understand the pro payer’s statutory filings with the state insurance commissioner  

The payer will have asked for a rate increase from state regulators. The basis for this growth can be helpful for your negotiation plan. Let’s see this example. If the payer has told the state insurance commissioner that provider prices are increasing by 4% annually, you must get in on the increase. 

Make sure you check your state’s insurance commissioner’s website for these filing documents and have any other requirements you might need. 

2. Ask the payer to analyze your claims before the negotiation meeting  

Sometimes payers do not take the time to investigate and analyze your business and how they can benefit from working together. For that reason, it is crucial that before the meeting about negotiations, you show the payer how your practice can save them money, assuming they support your assertion. 

3. Explain your practice’s value (include details)  

You, more than anyone, know the value of your practice and why it is relevant. Share details of your practice during the negotiation meeting. Explain why your practice is vital to employers, patients, the community, and, primarily, to the payer. Be prepared with data about your practice that you consider relevant to the payer. 

Highlight crucial details that make your practice stand out from other practices within your geographic area or specialty. 

4. Request an explanation of the pro payer’s network strategy  

You must understand how your practice fits into the payer’s strategy. Within this strategy, it is also essential to identify areas of opportunity and determine if there is a possibility of the payer channeling patients to your practice or if, on the contrary, it excludes them.  

Payers need to predict payment and claim activity to be successful. Whether the trend is up or down, you should know how this will affect your practice regarding this payer. Allow the payer representatives to explain their company’s strengths and challenges and how their vision can align with your practice. 

Learn more about optimizing your pro-payer negotiation skills to ensure reimbursement and maximize revenue collection. Feel free to reach us at [email protected]. Our team will set up a meeting to discuss how Health Prime can maximize your revenue.  

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