Contracting with Managed Care Organizations (MCOs), other insurance companies, Third Party Administrators, national networks and self-funded employers has become increasingly segmented and diffused. Since the “Risk” based contracting has waned dramatically over the past few years, the nature of payor relationships has devolved into:

a high volume, highly fractioned undertaking,
requiring a good deal of time commitment by staff, and
special expertise in

contracting language and terms,
reimbursement methods and
operational issues.

SERVICE COMPONENTS
Payor Contracting

MNH is structured to provide administrative efficiencies to both Purchasers and Providers of healthcare services, and to promote meaningful collaboration on improvements in the delivery of care in our region. To those ends, MNH engages in contracting with commercial and managed care payors on behalf of our Network. MNH continues to contract with a growing number and variety of Providers and Purchasers to help us support and strengthen our Network and to provide optimal access to high quality care.

In addition, MNH can assist a Provider in contracting directly with payors. MNH may not advise or negotiate for the Provider on the financial terms of the agreement. However, MNH’s experience with contract terms, payor contract documents and the overall negotiation process can help a Practice or Hospital achieve their contracting goals and avoid future operational problems.
Network Support

MNH is continually working to improve and expand its services to our Network with regard to the contracts we have executed, or other contracts that Providers have negotiated separately. Capabilities to respond to Provider problems and questions, contract monitoring and enforcement, advocacy and collections activities on behalf of Providers, improved education and communication initiatives, and expanded general Payor relations are important activities to assure our Network Providers have the necessary tools for effective third-party administration.
MNH provides a variety of settings for practices and hospitals to stay abreast of contract and payor issues and trends, as well as collaborative forums to facilitate collaboration among providers on how to address the challenges of the current environment.

At present, MNH holds regular meetings of the following groups, often in various locations around northern and eastern Maine:

Joint Operations Committees:

These payor-specific meetings are held about once per month to bring practice and hospital staff together with the local representatives of various payors, such as Aetna, CIGNA and Anthem.

Practice Manager Workshops:

These meetings bring practice managers and staff together to learn about current developments, contract issues and ways to improve office practice management.

BENEFITS

The support of our staff, with decades of experience in:

Contract negotiation and amendments
Reimbursements and incentives methodologies
Contract performance monitoring
Insurance and MCO operations
Issues advocacy and contract enforcement

COSTS

Most Network services are included in MNH membership.
Participation in MNH Network payor agreements is at not cost to the Provider.
The Provider may retain our services at a reasonable fee fore MNH assistance in contracting with other payors (i.e. direct contracting, not through the MNH Network agreements).