Healthcare Contract Management

Improve Payer Contract Management, Modeling and Reimbursement

Is your payer contract reimbursement at risk? Cumbersome contract loading and management can leave you out of sync with new contract terms and conditions exposing your health system to the risk of underpayments and declining revenues. IT and staffing constraints can also make it difficult for timely payer contract modeling placing your negotiations on unequal footing and in danger of adverse financial consequences.

Conquer the complexity of healthcare contract management and modeling while ensuring accurate payment from claim creation through the appeal process with ZirMed Contract Management. With ZirMed’s Contract Management solution, you can easily manage 100% of your contracts and terms in a centralized repository.

Simplify Change Management

Create, maintain and model contracts in real-time. Our intuitive software wizard translates complex terms into user friendly descriptions making it easy for your staff to load or update your contracts. Now you can manage payer contracts and ensure they are ready on the effective dates without incurring lost time or expense for vendor support. Of course, if you prefer, we can also load new contracts for you.

Gain Control of Outcomes

Model payer contracts to your advantage with our cloud-based “what-if analysis” that lets you use historical claims data to determine the impact of contract changes and new proposals. Now you have the tools to negotiate payer contracts and rapidly evaluate the impacts of changes your payer representatives propose. You can also compare multiple model iterations to anticipate the impact of changing demographics and service lines against your baseline to determine contract scenarios that yield the highest net revenue. Gain unprecedented insight into the impact of shifting payer terms as you manage the transition to value-based reimbursement.

Mitigate Financial Risk

Managing contract reimbursement is easy with ZirMed’s enterprise dashboard that analyzes contract payment variance across all your facilities. Your staff can quickly drill-down to contract payment variance at the claim, category and the line item level. Your staff gains the visibility to monitor payer contracts and hold payers accountable through institutional and professional reporting, payer scorecards and performance tools. ZirMed also alerts your managed care team to contracts approaching the end of their terms, so you have plenty of time for payer contract modeling. We identify which contracts are underperforming by term and contract utilization and share case rates, groupers and per diems that have total charges below the contracted rates, so you have essential knowledge to better negotiate payer contracts and engage counterparts making pricing decisions.

Expedite Revenue Recovery

Quickly assess payer intervention needed by comparing expected payer contract reimbursement and percentage of cash received across your enterprise and for each facility. Divide work by attributes such as timely filing, payer contracts, variance thresholds and violation types to speed recovery. Improve staff productivity and throughput by automating the appeals process with a pre-built form that provides supporting contract language and claim detail to the line item level for payment resolution.

Integration Capabilities

By design, ZirMed’s revenue cycle management platform enables creators of healthcare technology solutions to seamlessly and easily incorporate our HIPAA and PCI-compliant applications and transactions into your software solutions. Using ZirMed’s integration capabilities, organizations seeking a traditional approach of exchanging EDI transactions may transmit and receive a variety of claims, payments, eligibility inquiries, and other healthcare transactions using established technologies and methods such as X12 files, APIs, Flat Files, FTP, Encryption (i.e. PGP), and more. You’ll have confidence knowing that your exchanges are occurring securely, in compliance with all regulatory guidelines, and utilizing existing technological capabilities.

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