Challenge: The modern contracting burden
Contract management is a crucial and complex part of the healthcare revenue cycle. Today’s health systems are required to juggle hundreds of agreements – many of which require non-stop amendments and frequent renewals. The process involves ongoing negotiation between providers and payers, plus continuous monitoring by providers to ensure contract compliance.
When a large Epic®-based health system in the Northeast found itself struggling to keep up with the mounting volume of payer contracts and rapidly changing payer behaviors, the organization knew it needed a more efficient strategy to manage contracts.
“Payers have become more assertive and the sheer volume and complexity of these contracts can be overwhelming.”
Assistant Vice President (AVP) of Contract Compliance and Enforcement
The health system needed tools and technology to streamline the contract management process – from preparing negotiations to ongoing monitoring. To strengthen its negotiating position, the organization also needed more accurate data and reliable insights into payer performance.
Solution: Adopting a disciplined, data-driven contracting strategy
In response to their growing contracting burden, the health system developed a repeatable contracting process designed to keep every contract discussion focused and consistent. To build the structure and visibility needed for strong negotiating power, it implemented Experian Health’s award-winning Contract Manager and Contract Analysis, supported by Enhanced Claim Status and Payer Alerts.
The new approach includes the following four steps:
Step 1: Preparing for the negotiation
Every payer negotiation starts by using data to gain a clear understanding of the patient population, review rates and pinpoint problem areas to address.
“To negotiate effectively, organizations need to be just as prepared as the payers,” the organization’s AVP emphasized. “You have to leverage data that highlights trends, reimbursement delays and policy changes that could affect outcomes.”
During preparation for every negotiation, the organization focuses on:
| Preparing for negotiation |
| Understanding the patient population: Patients, their employers and the services used most often are first identified. Then, the batch functionality in Experian Health’s Insurance Eligibility Verification solution is used to determine which patients are still actively enrolled in insurance plans and elevate major employer groups that need to be prioritized. |
| Evaluating rates: Requested payer rate increases are carefully reviewed to assess necessity and determine whether a slight adjustment could be a better fit with the contract portfolio. Different rate scenarios are modeled using Contract Analysis to identify balanced rates and prevent individual plans from rising too high or falling too low. |
| Surfacing issues: Potential problem areas are identified and addressed using Experian Health’s Enhanced Claim Status to help prevent further escalation. |
Step 2: Automating active negotiations
When the negotiation process begins, the organization relies on Experian Health’s Contract Manager solution to streamline the process through automation.
| Automating negotiations |
| Managing proposals: Contract Manager centralizes proposals, runs alternative scenarios and maintains record revisions. |
| Analyzing financial impact: Proposed terms are modeled and evaluated at the service-line level to bolster negotiating power. With Contract Analysis, analysts can pressure-test rate structures against reimbursement to identify the best terms and audit payer performance for contract adherence. |
| Evaluating claims impact: Contract Manager analyzes expected outcomes using a claims-valuation engine and payer-specific logic. Before agreeing to new terms, the organization also runs historical claims data through Contract Analysis to better predict real-world financial impact. |
Step 3: Implementing contract compliance
The organization uses Contract Analysis to verify that negotiated terms are both captured correctly in the contract and successfully carried out by payers. Automating oversight allows the health system to easily confirm that new rate increases have been applied and verify that claims are being processed as agreed.
“We really have to stay on top of things and double-check everything ourselves,” the AVP emphasized. “Contract Analysis automatically tracks these issues through appeals functionality and work queues, making sure everything is implemented accurately.”
Step 4: Monitoring for unexpected issues
Payer policies evolve fast and often emerge without any warning. Complex new terms, compliance tracking needs and other factors can escalate contract issues quickly and sometimes undermine agreements altogether.
“Signing the contract is just the beginning – ongoing oversight is what keeps rates fair and favorable, says the AVP.
Experian Health’s Payer Alerts and Contract Analysis, used in tandem with Contract Manager, allow the health system to stay one step ahead in negotiations. Now there’s no need to search payer portals and changes can be modeled and analyzed to evaluate impact on current contracts.
Outcome: Stronger payer negotiations, more revenue recovery
Since implementing Experian Health’s Contract Manager and Contract Analysis and a new repeatable four-step contracting process, the health system has seen measurable improvements.
| Key outcomes: |
| ✓ $16.1 million recovered in 2025, an 8.7% year-over-year increase |
| ✓ 78.6% recovery rate in 2025 |
| ✓ A consistent, repeatable process that strengthens payer negotiations |
“We keep learning from every negotiation because policies, payers and the market are always changing,” says the AVP of Contract Compliance and Enforcement.
Every negotiation with payers is now guided by the new process and the organization continues to rely on Experian Health’s Contract Manager and Contract Analysis to deliver efficiencies and insights that shape all future negotiations.
Learn how Contract Manager and Contract Analysis from Experian Health helps healthcare organizations protect revenue and strengthen their negotiating position with payers.
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