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Payor Contract & Negotiation Management for Hospitals & Healthcare Providers

Macedon's Appian Expertise

In the complex landscape of healthcare, effective payor negotiation and contract management are pivotal to a provider's financial health and operational efficiency. Macedon Technologies, in partnership with Appian, offers a robust solution tailored to address these challenges head-on.  Transform your payor negotiation and contract management processes to improve financial outcomes and operational excellence.

Medical Industry-min

Key Challenges in Payor Contract Management

Many of our Healthcare Provider customers were encountering these pain points - sound familiar?:

  • Complex Negotiations: Coordinating among Revenue Cycle Management (RCM), Managed Care, Legal, Finance, and Operations departments can be intricate and time-consuming
  • Unstructured Contract Enforcement: Without a standardized system, enforcing contract terms becomes inconsistent, leading to potential compliance issues
  • Communication Gaps: Irregular communication, both internally and with payors, often results in misunderstandings and delays
  • Overwhelming Email Traffic: Reliance on email for critical communications leads to information overload and missed messages

Macedon's Integrated Solution

Macedon has built a comprehensive solution to streamline payor contract & negotiation management to address these common challenges:

  • Collaborative Platform: Tools that facilitate seamless coordination among cross-functional teams, enhancing strategic planning and execution
  • Centralized Contract Repository: A unified system that stores all contracts, ensuring easy access and enhanced visibility for all stakeholders
  • Automated Workflows: Digitization of paper-based processes reduces manual errors and accelerates contract lifecycle management
  • Standardized Communication Channels: Integrated systems that reduce dependency on emails and promote real-time collaboration and updates

Strategic Advantages

Beyond solving the pain points, Macedon's solution gives Healthcare Providers strategic advantages in Payor Negotiation and Contract Management.
  • Data-Driven Negotiations: Utilize comprehensive analytics on claim submissions, underpayments, and denials to inform negotiation strategies and achieve favorable terms
  • Payor Performance Scorecards: Implement performance metrics to educate payors and negotiate better rates based on objective data
  • Proactive Contract Termination Planning: Develop strategies for contract termination scenarios, ensuring preparedness for out-of-network transitions
  • AI-Powered Contract Analysis: Employ artificial intelligence to swiftly search and analyze contract terms and amendments, enhancing compliance and decision-making

 

 

 

Other Industry Use Cases

  • No Surprises Act - ONP, IDR, IDRE selection

  • Coding

  • Claims Submissions

  • Claims Appeals

  • Patient Journey Management / Care Coordination

 

 
  • Cash Posting, Accounts Receivable

  • IT Applications Management

  • Inbound Document Management

  • Change Control Management

  • Safety, Risk, & Compliance

  • Clinician Management

What are our Clients Saying?

“Thanks for your thoughtful solutions,
your anticipation of needs, and just being a great partner to work with.”

Product Owner at a
Regional Bank

“[Macedon] made this project
seem easy. Always prepared,
always on target.”

Product Owner at a Healthcare Organization

“[Macedon] proactively suggests process improvement items that had never occurred to me.”

Sponsor and AVP at an Insurance Organization

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Stage & Gate

Learn about Macedon's powerful, highly configurable stage-gate tool, Stage & Gate

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    Appian Solutions for the Healthcare Provider Industry

    Macedon Technologies has 15 years of experience in delivering industry-specific solutions, enabling us to develop a leading asset repository for the Appian Partner community. We empower Healthcare Provider companies to extend Appian’s out-of-the-box capabilities to meet their unique use cases, including regulatory compliance, scheduling, and insurance claims submissions. Our Appian solutions help these companies increase their revenue, reduce costs, and focus on customer outcomes.

     
    Find Out More

    By partnering with Macedon Technologies, companies in the Healthcare Providers industry can use Appian to automate processes related to:

    • No Surprises Act - ONP, IDR, IDRE selection

    • Claims Submissions

    • Patient Journey Management / Care Coordination

    • Home Health Automation

    • Regulatory Compliance

    Blog Post: Navigating the No Surprises Act's Challenges for Healthcare Providers

    The healthcare landscape has undergone significant changes with the introduction of the No Surprises Act, enacted on January 1, 2022. While this legislation aims to protect patients from unexpected medical bills, it has also introduced administrative headaches for healthcare providers. We have worked with customers to overcome these new complexities in a scalable way, to make sure they can continue to get paid for their critical services.

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    Navigating the No Surprises Act's Challenges for Healthcare Providers

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    Curious how Macedon can help simplify your work and processes? Let's get started.

     
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