Managed Care & Payer Relations

We assess your payer plan creation processes and perform a detailed review of your Epic payer plan master index to ensure plans are accurately built, properly mapped, and aligned with contract terms. This evaluation helps eliminate configuration errors that lead to underpayments, denials, delayed reimbursement, and reporting inaccuracies.

Our team evaluates, develops, and fine-tunes Joint Operations Committee (JOC) calls and structured escalation workflows with managed care payers. We help establish productive communication channels, define accountability, and create standardized agendas and documentation processes that lead to faster issue resolution, improved payer relationships, and stronger contract enforcement.

We facilitate Zero Balance Account (ZBA) audits and evaluate both internal and external methodologies used to validate payer reimbursement accuracy. This process ensures payments comply with contractually agreed-upon rates, identifies systemic underpayment trends, and uncovers revenue leakage that often goes undetected within routine operational reviews.

In addition, we develop a structured payer bulletin review process to help your organization stay ahead of policy updates and contract changes. By proactively monitoring payer communications and translating them into operational action, we help mitigate preventable denials, reduce rework, and protect revenue impacted by evolving payer requirements.