The CodeToolz Payer Contracting Team

We are continually honing our strategic and technical skills to successfully usher clients through reimbursement strategies and price negotiations.

The primary mission of CodeToolz is to help medical providers increase their revenue. It’s as simple as that. We are committed to making today’s era of reimbursement work for you.

Our ability to understand the issues that are important to both providers and payers affords us insight into the market dynamics impacting provider reimbursement and the technical skills needed to manage and optimize payer revenue streams.

With the current economy, insurance companies are tightening up, so it is very important that you utilize experts who are well versed in payer contracting strategies. We have the personnel and tools necessary to provide you with quantifiable results that directly impact your bottom line.

Payer Contracting, Credentialing and Negotiations Alliance

Because payer contracting is a tedious process that requires many-many steps and then multiple follow-up steps; our experts in the field take it on for you. They know how to engage with payers who are often more open to mutually beneficial reimbursement negotiations than you might imagine.

The CodeToolz Alliance has the expertise to undertake all your payer contracting, credentialing and negotiations with professionals who’ve worked on both sides of these conversations for decades. Our process has been proven to ensure your practice is able to maximize revenue for years to come.

Meet the Alliance Members

The CodeToolz Contract Analyzer is designed to track and manage your payer contracts, analyze fee schedules, manage options for payer negotiations and increase the bottom line.

Dana R. Bellefountaine Jr.

Founder & CEO

Payer Reimbursement Strategies

Our roots in payer contracting run deep, making CodeToolz one of the most effective payer contracting and reimbursement firms in the country.

While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5% to 12% due to lack of attention, this is devastating to your practice.

Fortunately, longstanding patterns of poor attention to contracts can be broken by managing, analyzing, renegotiating and monitoring your payer contracts. We believe in a proactive approach, not a reactive one.

Let the experts at CodeToolz take your contracting efforts from burden to competitive advantage. The bottom line is that in managed care contracting, knowledge is power and planning is essential.

Kathrin Pereira

Director, Product Development and Support

Microsoft Office and VBA Expert

Mrs. Pereira is responsible for the development and support of the CodeToolz Contract Analyzer. She has an extensive background in automation and development of multiple different tools and constantly works on improvements to give you the best possible user experience.

She is responsible for all Contract Analyzer lifecycle phases, from specifications and coding through deployment, testing, debugging, documentation, and maintenance. She is an expert in creating VBA programs to automatically update Excel workbooks, encompassing class and program modules and external data queries.

Mr. Ligon is the Founder of American Medical Network Inc.(AMN), a Healthcare Management Service Organization providing business and clinical solutions to the healthcare community for over 28 years.

Trey manages and develops IPA’s and large medical group networks throughout the United States. He brings a comprehensive medical administration knowledge in managing physician groups and forming large integrated medical practices for over three decades.

Through his relationship with many large insurance companies, he has represented and builds networks with Commercial HMOs, PPOs, Self-Insured Groups, Hospital Plans, Medicare Advantage Plans, Medicaid Networks and ACOs.

He brings an extensive knowledge in building, managing, creating and organizing large provider organizations into clinically integrated networks that can provide a risk structure for independent physician groups.

Trey also serves on many healthcare boards including, Insight Behavioral Health Network, National ACO, Accountable Care Inc. and The IPA Association of America, representing over 300,000 physicians across the United States.

Trey Ligon

CEO & President

Managed Care Contract Negotiations

American Medical Network Inc. (AMN) has provided all aspects of managed care management services to Independent Physicians for the last 25 years. Our customized management approach meets the unique needs of each of our clients and allows us to successfully manage smaller groups comprised of single physician practices along with large groups and all practice models in between.

REVIEWING CONTRACTS

Unlock contracts that give you more value for your services. Our team will identify the right contracts that fit your practice and match up your service area.

NEGOTIATING CONTRACTS

We have 3 decades of experience approaching payers for the best rates for new and existing contracts. We offer experienced and time-proven negotiations to bring you the best reimbursements available.

EXPAND CONTRACTS

Creating a long term relationship, we establish a partnership instead of short term agreements. There are many things to consider besides a good rate, including the impact on workflow, credentialing and the various products the payers offer.

PLAN RELATIONS

We develop the details for you to understand how each contract will apply to your organization. For example, you may be more interested in new products, employer affiliation or risk sharing models.

PROFITABILITY ANALYSIS

We focus on your return on investment in acquiring new contracts paid at better rates. Matching up the payer’s goals with your practice can open dialogue and new products that can offer opportunity.

CONTRACT MANAGEMENT

Assisting with managed care negotiations and contracting, assisting with compliance requirements, policies and procedures, referral authorizations, health plan audits, and regulatory changes; assistance with IPA policies and procedures; monitoring managed care contracts.

Our services have been designed to provide the best possible care in a budget friendly package. Our primary areas of expertise are provider credentialing & enrollment maintenance, practice start-up services, website design/deployment/practice marketing, compliance training and insurance contract negotiations.

Kimberly Evans

Nationwide MSO & Credentialing Services Company

Physician Practice Specialists was founded in 2007 providing specialized healthcare services to clients nationwide.

With offices in Florida, Tennessee and California and specialized practice consultants throughout the country, we provide services to over 2500 providers on a monthly basis.

Our clients include solo provider start-ups, large group practices, hospitals, prestigious universities and everything in between.

With our background and proven track record, you’re probably thinking that our services could never fit within your budget, this is where you’d be pleasantly surprised.

Our team is ready to utilize their experience and payer relationships to efficiently credential your organization and providers. We have packages for every organization regardless of size or scope.

A+ rated by the BBB and the only nationwide consulting and credentialing company to achieve this rating.