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Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

How do you negotiate a managed care contract?

Set Goals for the Relationship. When preparing to negotiate, organizations should think about the kind of payer-provider relationship they want. Look Beyond Rates. Address More than Just the Hospital. Develop a Payer Profile. Keep Your Options Open. Discussion Starters.

What is contract modeling in healthcare?

Negotiate Better Payer Contracts with Contract Modeling Using historical contract data, contract modeling software allows your healthcare organization to model thousands of various reimbursement combinations to understand the impact of the proposed payer contractual terms on your bottom line.

How does a health care provider indicate the obligation of providing care under a managed care contract that has been paid in ad

The healthcare provider would indicate the obligation for providing care when paid in advance through the insurance (prepaid insurance). Explanation: In the accounting recording, the healthcare service would indicate that the service was provided through the prepaid insurance and not through out-of-pocket payments.

Can we expect there to be contractual obligations when we receive medical care?

Healthcare providers enter into contracts with insurance companies. When you get contracted with any insurance as Participating provider you sign an agreement which says that you will accept their fee schedule and will not bill the patient excess to that amount. That's called contractual obligations.

What does contractual obligation mean?

Contract obligations are those duties that each party is legally responsible for in a contract agreement. If either party fails to perform their contractual obligations according to the contract terms, it will usually result in a breach of contract.

What does contractual obligation mean on an EOB?

Contractual Obligation is the portion of the reimbursement from a mayor that the provider cannot contractually expect payment for and cannot bill the patient for. It's referred to as a “write-off” amount above the Allowed Amount or usual and customary rate.

What is a managed care contract in a hospital?

Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. Health Maintenance Organizations (HMO) usually only pay for care within the network.

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