Estimate potential Revenue increase by re-contracting with payers at market rates
We compare your contracted billing rates to billing rates of providers like you, so you can re-negotiate higher rates.
The Opportunity.
Our health system client located in the North Midwest believed their contracted rates with a National health plan were below market. When we shared with them the level of detail health plans publish about contracted rates for all providers on a monthly basis, they were intrigued and immediately recognized the opportunity to “size the revenue potential” by securing an on-market contract. They engaged us to first validate their contracted rates published by this Payer and secondly compare their rates with regional health system competitors.
Medlyze Value-Add.
Medlyze proposed and implemented a complete payer price transparency data collection and analysis plan. Combining health system domain and technology capabilities, Medlyze was about to deliver insights in a matter of days. Working together with the client’s CFO and the finance team, we created an analysis tool kit and support model for the payer negotiation.
The analysis plan was vital in helping the health system’s financial team determine the revenue increase opportunity relative to prevailing market rates. Apart from this, the negotiation support model created by Medlyze allowed the finance team to rapidly analyze and evaluate the different contract terms as the negotiations progressed.
Client Results.
When we presented the payer price transparency data to the health system’s analytics team, they confirmed the hypothesis that they were paid a materially lower rate than others. They were now motivated to change that!
By using the analysis plan and negotiation support model developed by Medlyze and incorporating the findings into their payer negotiating strategy, the CFO was able engage the National health plan and achieve an improvement in the contract terms for the health system. This translated into a 10% annualized boost in revenue for patients covered by this Payer.
How Medlyze Helps Providers Like You:
Data as a Service
Directly access cloud database of In-Network and Allowed Amount negotiated rates for CPT, DRG, NDC, ICD, APC, HCPCS billing codes and providers with EIN, NPI numbers.
Insights as a Service
Use our web-based business intelligence visualization tool to view, filter, and analyze health plan and hospital negotiated rates data with drill down to billing codes detail and provider name detail.
AI Monitoring
Our Artificial Intelligence engine monitors negotiated rates for all billing codes and providers and notify you and your team when there is a change to be reviewed.