Efficient provider contract and fee schedule management is essential for healthcare organizations in both a “build” or “manage” the network status. Yet, many healthcare organizations continue to struggle with archaic provider contracting technology or processes, fragmented data including complex reimbursement arrangements, and manual downstream data entry to critical billing/claims applications.
Enter V12 Network—a powerful provider lifecycle management solution designed to optimize contract and fee schedule management through automation, pre-built workflows, and real-time data access.
The Challenges of Contract and Fee Schedule Management
Managing contracts and fee schedules involves navigating a web of complex provider relationships, reimbursement models, and regulatory requirements.
Common challenges include:
- Manual Processes: Many organizations still rely on paper-based workflows or antiquated provider contracting technology, leading to inefficiencies, errors, and delays in contract execution.
- Complex Reimbursement Arrangements: Tracking various pricing methodologies across different providers and networks is challenging without a centralized system.
- Lack of Data Integration: Disconnected systems make it difficult to access critical contract data, increasing the risk of inaccurate reimbursements and compliance issues.
These challenges hinder an organization’s ability to efficiently manage provider contracts, leading to operational inefficiencies and lost revenue opportunities.
Transforming Contract and Fee Schedule Management with V12 Network
V12 Network offers a comprehensive solution for provider contract and fee schedule management, addressing the key challenges faced by healthcare organizations. Let’s explore how V12 Network transforms this critical aspect of provider network operations.
Pre-Built Provider Contracting Workflows
With V12 Network, organizations can utilize pre-built payer and provider contracting workflows, designed to expedite the provider contracting process from start to finish. These workflows include dynamic contracting stages with automated task management, mass contract assignment by network parameters, integrated reimbursement data and pre-built interfaces to leading Contract Lifecycle Management applications, such as Conga, ensuring that every step of the process is tracked and executed efficiently.
Key capabilities include:
- Payer or Provider Contracting Processes: Pre-built workflows streamline contracting stages and ensure timely follow-ups.
- Document Storage and Navigation: Advanced provider hierarchies and affiliations make it easy to store and access critical contract documentation.
- Dynamic Provider Directory Business Rules: Automatically include or exclude non-par vs. par providers based on contract status.
Comprehensive Fee Schedule Management
V12 Network simplifies fee schedule management with up to 44 pre-built pricing templates across the most popular reimbursement models. The platform also offers the flexibility to create custom templates to meet specific organizational needs.
Key features include:
- Robust Pricing Term Creation: Create custom pricing terms on the fly with mass assignment workflows to new providers using the V12 Fee Schedule Stencil.
- Custom Fee Schedule Pricing: Set pricing at the modifier level to account for variations in reimbursement models such as traditional fee for service for inpatient and outpatient settings, percentage of charge, case rate, per diem, HCPCs and DRG codes, value-based care arrangements and capitation models.
- Advanced Reporting and Analytics: Generate financial network reports with real-time insights by network, state, discount, fee code, or value-based care arrangement.
Integration with Conga for Enhanced CLM
To further enhance contract lifecycle management, V12 Network integrates with Conga, a leading CLM solution. This integration enables organizations to leverage advanced features such as custom contract templates, amendment clause library management, automated data merging, version control, and electronic signatures.
Real-World Application: Streamlining Provider Contracting
For many organizations, provider contracting is an extension of network development. V12 Network manages the entire provider onboarding process through opportunities, tracking provider groups at a TIN level and individual associated practitioners at an NPI level. The platform’s contracting workflows ensure that contracts are generated, executed, and managed efficiently, with full visibility into associated fee schedules and network participation.
By leveraging V12 Network, healthcare organizations can:
- Reduce Time to Contract Execution: Automated workflows eliminate the need for manual paperwork and reduce delays.
- Enhance Data Accuracy: Centralized contract data ensures that all parties have access to the most up-to-date information.
- Streamline Contracting Workflows: Manage contracts from creation to execution with dynamic stages, task management, and approval tracking to reduce bottlenecks.
Provider Contract and Fee Schedule Management with Virsys12
Managing provider contracts and fee schedules doesn’t have to be a complex, time-consuming process. V12 Network offers a comprehensive solution that streamlines contract workflows, simplifies fee schedule management, and provides real-time insights into critical data. By automating key processes and integrating with leading CLM solutions like Conga, V12 Network empowers healthcare organizations to optimize their contract and fee schedule management, ultimately improving operational efficiency and revenue cycle management.
Ready to transform your contract and fee schedule management processes? Contact Virsys12 today to learn more about how V12 Network can help your organization achieve its goals.