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Provider Contracting

The Provider Contracting solution enables health plans to reduce contract administrative costs, while increasing provider payment accuracy. It enables the management of the provider contracting lifecycle through the automation of contract authoring, offering negotiating and acceptance. With flexible integration to downstream systems, it enables the decrease of the contracts to claims gap. Additionally, through contract analytics, this solution improves the visibility of inventory management, standards adherence and clause distribution.

Business Challenges:

• Ballooning administrative costs of paper-based provider contract management
• High cost of audit and provider payments
• Sub-optimal medical expenditures driven by inconsistent/nonstandard language
• Regulatory and provider pressure for contract intent transparency
• The shift to outcomes-based contracting increasing contracting complexity
• Claims leakage caused by error prone, manual interpretation and loading of contracts
• Inconsistent understanding of contract coverage and impact

Key Features:

• Centralized repository for provider contracts and images
• Standard contract clause and template
• Configurable contract workflows for end-to-end contract lifecycle management (ex., offer, negotiate, review and escalate)
• Online support for negotiation, signatures and transparency
• Rules-driven contracting standards, compliance enforcement and reporting 
• Offering wizards to automate customization of contracts for a given provider
• Automated codification of the contract and loading into MHS’s PIM and Reimbursement Systems
• Bulk contract amendment and re-contracting support
• Analytics for provider contract inventory management, standards adherence and clause distribution

Key Benefits:

• Reduction in contract administration costs
• Reduced medical expenditure driven by contract standards adherence
• Reduced claims leakage and claims mis-payments
• Enhanced provider satisfaction
• Improved regulatory compliance
• Increased speed to market of payment innovation