Lane 03 · Payer Contracting

A signed contract is a fee schedule with a story.

Most practices don't know exactly what their payer agreements say — they know the rate that comes back when they bill, and they assume the rest is fine. The rest is often not fine. We read the contracts, find the gaps, and negotiate the ones that move.

Talk to us about contracting

Methodology

How contracting works with us.

  1. Contract intake + read

    Send us your current payer agreements. We read every one — fee schedules, term and termination clauses, timely-filing windows, prompt-pay language, escalation language, silent-PPO and most-favored-nation clauses, and the appendices most people never open. You get a one-page read of what each contract actually says, in plain language.

  2. Benchmark + gap analysis

    We compare your fee schedules against Medicare-equivalent and against what comparable practices in your market and specialty negotiate. Where the gap is real and defensible, we mark it as a negotiation target. Where the gap is what it is, we tell you so you don't waste a cycle.

  3. Recontracting or new contracting

    We open the conversation with the payer, submit the rate request with the supporting case, and work the back-and-forth. New-practice startup contracting follows the same path — the difference is we're establishing the relationship, not renegotiating it.

  4. Execution + platform record

    Signed agreement, effective date, fee schedule, and the negotiation history all land in Metolius alongside the credentialing record. You see the agreement as it is, and the rate as it should bill — so the next time you audit a payment, you know what it was supposed to be.

Questions, plainly answered

The asks we hear about contracting.

  • What kind of rate increase should I expect?

    Depends on the payer, the market, the specialty, and how long since your last negotiation. We don't promise a number before we read your contracts and benchmark them. After the read, you get a realistic range — and the criteria we'll use to ask for it. If the answer is this contract isn't movable right now, we tell you.

  • Can you negotiate with all major commercial payers?

    Yes — UnitedHealthcare, Aetna, Anthem and BCBS plans, Cigna, Humana, the regional plans, Medicare Advantage plans. Medicare and Medicaid fee schedules are set, not negotiated — but the contracting around them (HMO/PPO carve-outs, Medicare Advantage, managed Medicaid) is negotiable and we work it.

  • What about new-practice startup contracting?

    Yes. Brand-new practices and facilities need to be contracted with every payer they intend to bill — there's no existing agreement to renegotiate. We run startup contracting as its own track, with credentialing and enrollment running in parallel so the practice can bill on day one.

  • Do you handle the legal review of contract language?

    We read for the business terms — rates, term/termination, timely filing, escalation, silent PPOs, most-favored-nation. For specific legal questions (state regulatory exposure, indemnification language, anti-kickback considerations), the call should go to your healthcare attorney. We flag the questions; we don't pretend to be your lawyer.

  • Can payer contracting be a standalone engagement?

    Yes. Many practices already have credentialing handled and only want help with payer contracting. We can run contracting on its own, or alongside credentialing and maintenance.

See what your payer agreements actually say.

Send us your current agreements. We read them, benchmark them, and tell you which we can move and why. Contracting can stand alone or run alongside credentialing and maintenance.

Talk to us