Feature

Payer Contract Management

Centralize payer information with fee schedule management, timely filing rules, and contract terms. Compare actual reimbursements against contracted rates to identify underpayments.

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Works with

Claims Submission & TrackingSubmit, track, and manage insurance claims with real-time status updates and automated scrubbing.
Payment PostingPost insurance and patient payments with full audit trail and automated reconciliation.
AR Management & AgingTrack accounts receivable with aging reports, follow-up queues, and priority scoring.

Every payer is its own small rulebook: a fee schedule, a timely-filing limit, an appeal window, a list of procedures that need authorisation, and a set of claim edits that differ from the next payer’s. When that rulebook lives in a biller’s head, it leaves when the biller does. Payer Contract Management puts it in the platform, where the scrubber, the posting engine, and the A/R queues can all read it.

Fee schedules are loaded per payer and per contract period, so an ERA payment can be compared with the contracted allowable for that procedure on that date. A payment under the contracted rate is flagged as an underpayment with the difference, which turns a vague sense that a payer pays short into a list of claims and dollars to pursue.

Timely-filing and appeal limits are stored per payer and drive the deadlines on every claim. Enrollment status is tracked per provider and payer, so a claim for a provider who is not yet effective with that payer is flagged before submission rather than denied after it.

Key Benefits

Fee schedule management

Contract term tracking

Underpayment detection

Payer directory

What payer management does

Payer directory

Payer IDs, addresses, portals, phone numbers, and clearinghouse routing in one record per payer, shared across every practice on the platform.

Fee schedules by contract period

Contracted allowables per procedure and modifier, dated, so the right schedule applies to each date of service.

Underpayment detection

Each posted payment is compared with the contracted rate. Shortfalls are flagged with the difference and queued for follow-up.

Timely-filing and appeal rules

Filing and appeal windows per payer drive the deadline clocks on claims and the ordering of A/R queues.

Enrollment status per provider

Which providers are effective with which payers, and from what date, so a claim for a provider who is not yet enrolled is flagged rather than denied.

Payer-specific claim edits

Required modifiers, authorisation flags, and format quirks per payer feed the claim scrubber directly.

How It Works

Load

Payer details, contract terms, and fee schedules are entered or imported once per payer and dated.

Apply

The scrubber, posting engine, and A/R queues read the payer record automatically. No biller has to remember a rule.

Compare

Payments are checked against the contracted allowable as they post, and shortfalls are flagged.

Renegotiate

Payer performance and underpayment totals by payer give the practice the numbers it needs when a contract comes up for renewal.

Frequently asked questions

What is an underpayment and how is it found?

An underpayment is a payment below the rate the payer contracted to pay for that procedure. The platform compares each posted payment with the fee schedule for that payer and date of service and flags the difference, so underpayments become a worklist with dollar amounts rather than a suspicion.

How does the platform know a provider is enrolled with a payer?

Enrollment status and effective dates are recorded per provider and payer. A claim for a provider who is not yet effective with that payer is flagged before submission with the reason shown, instead of being sent and denied.

Can one payer record serve several practices?

Yes. Payer identity, routing, and general rules are shared, while contracts and fee schedules are stored per practice, because two practices rarely hold the same contract with the same payer.

What is a timely-filing limit?

It is the deadline, counted from the date of service, by which a payer must receive a claim or it will deny it as late regardless of merit. The limit differs by payer and often by contract, and the appeal window after a denial is a separate clock. The platform stores both per payer and shows the days remaining on every open claim, so the queue surfaces a claim before its deadline passes rather than after.

Financial Reporting

Ready to transform your payer contract management?

Built for healthcare practices that are done fighting their billing software.

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