Payer Contract Analysis

Boost Your Earnings And Expedite Payments With Better Payer Contracts

Our team of experts specializes in conducting thorough and comprehensive payer contract analysis to identify the strengths, weaknesses, and improvement opportunities of your existing contracts. Once we have an understanding of the terms and conditions, we take the time to explain any potential threats and risks associated with unsatisfactory contracts, ensuring that you are fully informed of the negotiation needs.


TriumpHealth’s team of seasoned financial consultants conducts an exhaustive review of your contracts to gain a thorough understanding of the contract terms and analyze the language utilized by the payers. This payer contract analysis process enables us to discern crucial factors that provide providers with leverage during negotiations. Our consultants possess an elevated level of comprehension of these essential elements, allowing for a more comprehensive and effective analysis of payer contracts. Take a look at the factors mentioned below:

  • Fee Schedule
  • Reduction Rates
  • Relative Value Units (RVUs)
  • Timely Filing Rules
  • Patient Volumes
  • Claim Filing Limits
  • Appeals Qualifications
  • Market Value Based on Taxonomy

What Triumphealth Can Deliver To Your Payer Contracting?

This is how we deliver value to you:

  • Understanding Your Driver For Payer Contract Negotiations:
    We first listen, to understand your needs and goals for payer contract negotiations; then provide customized, value-added solutions. For instance, which one or more of the following reasons is causing you to consider negotiating your payer contracts:

    • Increase in Revenue
    • Expanding your Payer Network
    • Increase the Patient Base or Lives Covered
    • Higher Market Penetration
    • Become More Competitive in Your Jurisdiction
  • You Can’t Manage What You Can’t Measure:
    To help you manage your revenue, we conduct a thorough payer reimbursement analysis, including:

    • Identifying high-volume and high-value medical procedures and services rendered at your medical practice or healthcare organization
    • Reviewing the fee schedules and reimbursement rates of payers you want to negotiate with for above procedures and services
    • Analyzing the payer’s reimbursement policies, such as deductibles, copayments, and coinsurance, to understand how they affect the amount you will be reimbursed for each claim
    • Researching gaps in reimbursement between contracted amounts and payments received for specific CPT’s
  • Establish Key Payer Contract Negotiation Differentiators:
    When requesting a reimbursement rate increase, we help illustrate the value you offer to the payer, as compared to the competing healthcare organizations in your jurisdiction. For instance, does your practice offer services in multiple languages, or extended business hours during weekdays, or telehealth appointments etc. Similarly, do you have expert providers in niche areas of your specialty that can cater to specific patient diseases.
  • Data-Driven Negotiations:
    Our data-driven approach leverages our extensive database of market rates in your jurisdiction and established relationships with health plans to secure the most favorable contract terms.

Get Ahead Of The Competition With Us!

In the ever-evolving healthcare industry, staying ahead of the competition requires a reliable and trusted partner that can provide expert advice on payer contract analysis and payer contract negotiations. That’s where TriumpHealth’s experience with payer networks comes in handy and is valuable to you. Get in touch with us today to learn more about how we can assist you in maximizing revenue and staying ahead of the competition.

To talk to a representative, call 888-747-3836 x0 or email