Contract Review & Payor Research
Congratulations! You've secured a contract with an insurance carrier. Now what? How do you make sure you abide by the terms of the contract? What exactly are the terms of the contract? What are your rights under the contract? What are the payor's reimbursement policies? Where do you find those?
TLC Credentialing and Consulting offers a comprehensive review of each of your payor contracts, as well as key reimbursement policies. We will review your contract for key information that you need to know. We will also review the payor's reimbursement policies/manual from their website for additional information that is not directly stated in your contract.
For each contract/payor we review, you will receive an Excel spreadsheet breaking down key components of your contract. You will also recieve a Sharepoint folder with any additional applicable resources from the payor's website (reimbursement manual, provider handbook, FAQs, etc). Note that this review is reimbursement focused, but will include basic clinical compliance requirements.
- Some of the information we provide during a contract review includes:
- Initial claims timely filing deadline
- Timely filing deadline for corrected claims and appeals
- Billing codes and applicable modifiers
- How long the insurance company has to pay a clean claim
- Unique provider requirements (requires an RBT, requires provider to be CPR certified, etc)
- Appeal procedures
- Important contact information (Claims Dept, Provider Relations Dept, general contacts)
- Basic clinical guidelines
- Anything else you want to know! Just ask!
Provider Requirements
Claim Filing Deadlines
Clinical & Coverage Policies
Contact Information
Your Rights Under the Contract
Each payor contract and policy review is $80/hour. Most commerical payor contract reviews take about an hour, while most Medicaid reviews will take about 2 hours.
Compliance with the terms in your contract is essential to minimize legal and financial risk to your practice. Don't let "I didn't know," put your practice at risk!