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Insurance Contract Negotiation Services

Unlock the rates your practice truly deserves. At NGA Healthcare, we have a 100% success rate in negotiating contracts, ensuring that every one of our clients secures at least one major contract. Let us help you maximize your practice’s potential!

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Experience the difference of our expert contract negotiation team

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Significant Revenue Boost 

Benefit from substantial fee schedule increases, averaging 10-20%, directly impacting your bottom line.

Accelerated Contract Negotiations

Experience faster contract negotiations, outpacing what groups or competitors can achieve on their own.

Maximize Payer Revenue

Protect and enhance your revenue by combating the impact of declining reimbursements through strategic negotiations.

Comprehensive Contract Management

Enjoy seamless contract management, from initial negotiations to credentialing, application submission, and rate setting.

Tailored Procedure Negotiations

Ensure the most important codes and procedures for your practice are prioritized and secured during contract negotiations.

Testimonial image of doctor from Pinnacle Internal Medicine
"After trying for nearly two years, NGA Healthcare was able to get my practice an increase in only three weeks! This will add over $150,000 to our bottom line."

- Pinnacle Internal Medicine

The Contract Negotiation Process

As a medical professional, your primary focus should be on your patients—not on the time-consuming task of negotiating payer contracts. At NGA Healthcare, we take the burden off your shoulders with a meticulous approach to payer contract negotiation, ensuring you receive the best possible reimbursement while you concentrate on what you do best: caring for your patients.

1
Initial Consultation

We kick off with a detailed consultation to assess the current state of your contracts and identify pain points specific to each practice.

2
Tailored Proposal

NGA submits a customized proposal outlining the process, fees, and strategies designed to maximize your revenue potential.

3
Comprehensive Data Collection

Once you engage our services, we provide a detailed list of required data points and information. This enables us to conduct a thorough analysis of your rates and craft a compelling value proposition.

4
In-Depth Reimbursement Analysis

We meticulously benchmark your practice's allowable rates by individual CPT codes against Medicare, providing a granular understanding of your financial baseline.

5
Strategic Value Proposition Development

We create a robust value proposition that showcases your practice’s unique strengths and cost-saving opportunities, tailored specifically for each health plan.

6
Persistent Negotiation Process

Our team submits the value proposition to each plan and rigorously negotiates on your behalf. We are relentless in our pursuit, making a compelling case for increased rates and refusing to accept “No” as an answer.

NGA is dedicated to securing higher rates for your practice. Even in the face of prolonged stalling and delays, we persist in negotiations until we achieve the increase your practice deserves.

A Case Study of a Payer Contract Negotiation

This medium-sized practice has been open for 6 years and has a roster of 5 medical doctors and 3 mid-level providers. Annual Revenue is $4,650,000* broken down according to the following payment mix:

Medicare - 25%
Medicaid - 10%
Commercial Payer 1 - 20%
Commercial Payer 2 - 10%
Commercial Payer 3 - 10%
Commercial Payer 4 - 20%
Commercial Payer 5 - 5%

After a comprehensive meeting to scrutinize and discuss our strategy, leverage, and competitive advantages, we analyzed the practice’s CPT codes according to the payers above and weighted the number of encounters.

We found what each of the payers was reimbursing, as compared to Medicare…

payers reimbursed vs. Medicare graph

You’ll notice Payers 1, 2 and 3 are paying at a similar rate. Payer 4, on the other hand, is pulling the average down, and Payer 4 is one of our largest payers. This was seriously impacting the practice’s finances. So, how did NGA proceed? We created an irrefutable value proposition and a strong negotiation strategy.

The Outcome

Using our long-standing health plan contacts, we started the several month-long negotiation process. Even after initially refusing any increases, the Payer ultimately agreed to an 18% increase over current rates from 78.25% to 96.25%. The result?

An extra $168,483 PER YEAR, year after year!

All of that revenue was essentially profit for the practice. No additional expenses were required to increase their bottom line.

All with just ONE payer. Imagine what that could mean for your practice.

Specialties we have worked with

  • Ambulatory Surgery Centers (ASCS)
  • Allergy & Immunology
  • Addiction and Drug Treatment Centers
  • Anesthesiology (Pain Centers)
  • Behavioral Health (Psychiatry/Psychology)
  • Cardiology
  • Dermatology
  • Dentistry
  • Ear, Nose, and Throat
  • (ENT/Audiology/Otolaryngology)
  • Emergency Medicine
  • Gastroenterology
  • Interventional Radiology
  • Imaging Centers Labs
  • Neurology
  • Obstetrics & Gynecology
  • OBLs (Office Based Labs)
  • Ophthalmology & Optometry
  • Orthopedic
  • Pain Management
  • Primary Care
  • Podiatry
  • Radiology-Diagnostic
  • Surgery (General, Eye, Endovascular, Hand, Orthopedic, Retinal, Spinal, Vascular, etc)
  • Urology
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Get a Free Consultation

Contact NGA Healthcare today to see how we can help optimize your practice.

Frequently Asked Questions

How can my medical practice benefit from professional insurance contract negotiations?
Any group that has contracts with payers that has not been negotiated in the last three years.  In most cases, we find most physicians need our services as they have never negotiated their contracts since they started their practice.

What is the typical timeline for completing the negotiation process?
On average renegotiations take 7 months, and new contract negotiations average between 4-8 months, but it's highly dependent on the individual payers.

How much involvement is required from my practice during contract negotiations?
Very little as we have a team of expertise that can do the work for you.  The practice will be involved in the initial kickoff call wherein we will engage the practice to get the necessary data to model your potential current revenue and potential offers..  We will then meet with you if desired to share with you the analysis.  After this point, our team will be the lead in all the negotiations and will not need any involvement from the practice.  We are happy to meet with the practice to provide updates and any details on offers.  We do not accept any offers unless the provider approves.  

Can NGA Healthcare manage negotiations with multiple insurance providers simultaneously?
Yes, absolutely and we do every day.  We have a team of over 50+ including skilled negotiators, analysts, and a provider services team that have specialized and worked with almost all payers including United Healthcare, BCBS, etc.

What happens if the negotiation process does not yield the desired results?
This is very unlikely to occur as we’ve successfully negotiated for over 99% of our clients.  In the event that we aren’t able to obtain a new contract or negotiate an increase on an existing contract, we will return any qualifying and guaranteed initiation fee we collected.

Does NGA Healthcare offer ongoing contract management and fee schedule updates as part of their services?
No, NGA Healthcare only charges initiation fees (which are guaranteed as long as we negotiate at least 5 health plans), and performance bases fees.  Essentially, don’t get paid unless we obtain a new contract or increase.

What steps are involved in the insurance contract negotiation process?
The first step after signing an agreement with NGA Healthcare and paying any associated initiation fee is the kickoff call. During the kickoff call we go over the welcome kit, which is an online form for sharing practice information needed for negotiations.  NGA then uses this information to submit offers, and request any missing contracts/fee schedules needed to model the practice’s rates.  If it’s a new group then we are also submitting all the applications, and starting the negotiation process.  Once the increased offers or new contract offers are obtained, NGA Healthcare will share them with the client, and facilitate the signature of the agreements if the rates are acceptable. 

What are the fees associated with contract negotiation services?
We charge an initiation fee (which is guaranteed if we don’t get any increases) that is determined by your practice size/specialty/location, flat fees for new contracts, or a percentage of the value brought to your practice.

What rate increases can typically be expected from successful negotiations?
Increases and rates vary greatly depending on a number of factors including: specialty, location, size of the group, facility type, age of the contracts, etc.  

Is it worthwhile for me to negotiate my insurance contracts?
Every group should be negotiating their payer contracts as often as possible. Negotiating contracts before you sign them is the most important time to negotiate.