Payer contracting for practices and medical companies can be an overwhelming and daunting task. The purpose of this article is to help you, as a provider or medical company, to focus on ways that will help you get contracted with payers and to renegotiate agreements. It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there is a bureaucracy. One of the definitions in Webster’s Dictionary of bureaucracy is: “a system of administration marked by officialism, red tape and proliferation”. All large and successful companies have bureaucracies and they are necessary to maintain the order and success of these organizations.
Therefore, the first tip of the day is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager in the payer’s organization. Often payers have unique organizations in each state. Therefore, generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to instead send these requests to provider relations or to another department.
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