Challenge: The modern contractual burden
Contract management is a crucial and complex part of the healthcare revenue cycle. Today’s healthcare systems must juggle hundreds of agreements, many of which require constant amendments and frequent renewals. The process involves ongoing negotiation between providers and payers, as well as ongoing monitoring by providers to ensure contract compliance.
When a large Epic®-based health system in the Northeast struggled to keep up with the growing volume of payer contracts and rapid changes in payer behaviors, the organization knew it needed a more efficient strategy for managing contracts.
“Payers have become more assertive and the sheer volume and complexity of these contracts can be overwhelming.”
Assistant Vice President (AVP) of Compliance and Contract Execution
The health system needed tools and technology to streamline the contract management process, from preparing for negotiations to ongoing monitoring. To strengthen its negotiating position, the organization also needed more accurate data and reliable insights into payer performance.
Solution: Adopt a disciplined, data-driven hiring strategy
In response to its growing contractual burden, the health system developed a repeatable contracting process designed to keep each contractual discussion focused and consistent. To build the structure and visibility necessary for strong negotiating power, he implemented Experian Health’s award-winning program. Contract Manager and Contract Analysisbacked by improved claim status and payer alerts.
The new approach includes the following four steps:
Step 1: Preparation for negotiation
Every payer negotiation begins by using data to gain a clear understanding of the patient population, review rates, and identify problem areas to address.
“To negotiate effectively, organizations must be as prepared as payers,” emphasized the organization’s executive vice president. “Take advantage of data that highlights trends, reimbursement delays and policy changes that could affect results.”
During the preparation of each negotiation, the organization focuses on:
| Preparing for negotiation |
| Understand the patient population: Patients, their employers, and the most frequently used services are first identified. Next, batch functionality in Experian Health Insurance Eligibility Verification The solution is used to determine which patients are still actively enrolled in insurance plans and highlight top employer groups that should be prioritized. |
| Rate evaluation: Requested payer rate increases are carefully reviewed to assess need and determine if a slight adjustment could better fit the contract portfolio. Different rate scenarios are modeled using Contract analysis to identify balanced rates and prevent individual plans from going too high or too low. |
| Problems that emerge: Potential problem areas are identified and addressed through the use of Experian Health. Improved claim status to help prevent further escalation. |
Step 2: Automate active negotiations
When the negotiation process begins, the organization relies on Experian Health’s expertise. Contracts Manager solution to streamline the process through automation.
| Automate negotiations |
| Proposal management: Contracts Manager centralizes proposals, executes alternative scenarios, and maintains record reviews. |
| Financial impact analysis: Proposed terms are modeled and evaluated at the service line level to strengthen bargaining power. With Contract analysisAnalysts can test rate structures against reimbursement to identify the best terms and audit payer performance to determine contract compliance. |
| Assessment of the impact of claims: Contracts Manager analyzes expected outcomes using a claims rating engine and payer-specific logic. Before accepting new terms, the organization also analyzes historical claims data through Contract analysis to better predict real-world financial impact. |
Step 3: Implement contract compliance
The organization uses Contract analysis verify that the negotiated terms are correctly reflected in the contract and that payers successfully apply them. Automated monitoring allows the health system to easily confirm that new rate increases have been applied and verify that requests are being processed as agreed.
“We have to be aware of everything and check everything ourselves,” stressed the AVP. “Contract Analysis automatically tracks these issues through appeals and work queue functionality, ensuring everything is implemented accurately.”
Step 4: Monitor for unexpected issues
Payer policies evolve rapidly and often emerge without warning. Complex new terms, compliance monitoring needs, and other factors can quickly escalate contractual issues and sometimes undermine agreements entirely.
“The signing of the contract is just the beginning: constant supervision is what keeps rates fair and favorable,” says the AVP.
Experian Health Payment alerts and Contract analysisused in conjunction with Contracts Managerwill allow the health system to be one step ahead in the negotiations. Now there is no need to search payer portals and changes can be modeled and analyzed to evaluate the impact on current contracts.
Result: Stronger negotiations with payers, greater revenue recovery
Since the implementation of Experian Health Contract Manager and Contract Analysis and a new four-step repeatable contracting process, the health system has seen measurable improvements.
| Key results: |
| ✓ $16.1 million recovered in 2025, an 8.7% year-over-year increase |
| ✓ Recovery rate of 78.6% in 2025 |
| ✓ A consistent and repeatable process that strengthens negotiations with payers. |
“We continue to learn from each negotiation because policies, payers and the market are always changing,” says the Assistant Vice President of Compliance and Contract Enforcement.
All payers are now guided by the new process and the organization continues to rely on Experian Health’s expertise. 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.