Experian Health Contract Manager is a comprehensive revenue cycle management (RCM) solution designed for hospitals, health systems, and large medical groups to ensure accurate reimbursement and maximize revenue recovery. The solution continuously audits payer contract performance to verify that collections align with negotiated terms.
Key Capabilities & Benefits:
- Reimbursement Accuracy: Verifies contractually allowed amounts for all applicable claims by comparing expected payments to actual reimbursements.
- Underpayment Recovery: Identifies discrepancies and contractual appeal opportunities, allowing for efficient and accurate mass appeals to recover lost revenue.
- Contract Modeling & Negotiation: When paired with the companion solution Contract Analysis, it allows providers to model the financial implications of proposed contracts using their own claims history to negotiate more favorable terms.
- Payer Compliance: Monitors payer adherence to contract terms and applies current reimbursement rules for Medicare and other payers, reducing the risk of audits and penalties.
- Workflow Efficiency: Defines specific contract terms, fee schedules, and payment policies using a powerful multi-payer claims valuation engine, and provides real-time visibility through configurable online dashboards and reports.
The system is deployed as a secure, web-based solution that seamlessly integrates with existing hospital information and practice management systems, minimizing IT involvement. It is consistently recognized as a top performer in the Revenue Cycle: Contract Management category by KLAS Research.
