4 Managed Care Questions Regarding Claims Payments

Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these two questions during negotiations within managed care contracts regarding claims payment and covered services.

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1. What is the payor’s track record concerning payment of claims? What is the payor’s current financial position?

2. Does the contract target a specific segment of the market not previously reached in other contracting opportunities?

3. Can the providers bill their usual charges for non-covered services?

4. Are noncovered services properly defined?

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