Payer Contracting

Managed care contracts might be key to your ability to convert more of the calls you receive. When you turn clients away that need an in-network facility, you are left only with the option: a single case agreement. This requires a lot of work on the part of the member, which likely means you lose the call and are left with an empty bed. In addition, many facilities that bill on an out of network basis may get a decent rate but are subject to audits that may require them to refund money to the payer after claims have been paid.

Managed care companies vary in how they contract with behavioral health facilities. They have different licensing, staffing requirements, length of stay, utilization review, billing processes and rates they are willing to pay.  The decision to contract with managed care companies is a time consuming, daunting process that requires competitive analysis, knowledge of the current payor landscape, and thoughtful marketing presentation. Positive, ongoing relationships with managed care contract negotiators helps us to streamline the process.

Census by Design can work with you to develop a strategic plan and execute managed care contracts that are beneficial for your organization.

We can help you:

• Review of current contract rates
• Identify of potential new contracts
• Lead contract negotiations
• Manage the credentialing process

We have long standing experience with the following payors:

• Anthem
• Blue Shield of CA
• Kaiser Permanente
• Cigna/Evernorth
• United Healthcare/Optum
• Healthnet/MHN
• Sharp Health Plan
• The Holman Group
• Firsthealth
• Compsych
• Tri-Care