Payer Contract – Actual Contract (Messenger Model)

You know there is a lot that goes into a managed care contract (MCC) – view Managing Your Payer Contracts Like a Pro.

Our focus for this page is on the Reimbursement Methodology and the Amendment. As you can see this contract has a “stated” year (2015) of Medicare, it can also be “current” year – this is important.

If on 1/1/16 the allowables go up – do you trust the Payer to just move you to the new higher paying fee schedule? Do you even know if your allowables are going to go up (or down)? You can bet if the allowables go down, your Payer is going to get you on that lower paying fee schedule on 1/2/16.

This leads us to the Amendment – your allowables are moving one way or the other, which way will it be and will you be ready within the 30 day Amendment period to act accordingly?