Contracting

We manage contract negotiations with commercial insurers, Medicare Advantage, and Medicaid to secure favorable reimbursement rates and terms for the providers we support. This includes advocating for fair fee schedules, reviewing contract language, and aligning payment structures with practice goals to promote financial sustainability and allow providers to focus on delivering quality care.

Guidant MSO closely monitors contract terms and reimbursement patterns to identify underpayments, claim denials, or breaches of agreed terms. We conduct audits to ensure payments align with negotiated rates and promptly initiate appeals or reconciliations when discrepancies arise. This oversight helps maximize revenue, reduce administrative burden, and ensure payers uphold their contractual obligations.

Guidant MSO oversees the full credentialing and recredentialing process to ensure providers are enrolled with commercial, Medicare, and Medicaid payers and remain compliant with billing and network participation standards. We manage documentation, submissions, tracking, and ongoing monitoring to prevent lapses and support timely reimbursement.

We help practices join or form Independent Physician Associations (IPAs), Accountable Care Organizations (ACOs), or other provider networks to enhance negotiating power and improve care coordination. Our support includes strategic guidance, legal setup, and assistance with contracting and operations. By fostering collaboration, we help providers access shared resources, engage in value-based care models, and strengthen their position in the healthcare market.

We develop, implement, and manage standardized fee schedules across provider contracts to ensure consistency, profitability, and compliance with payer agreements. This includes analyzing reimbursement trends, aligning rates with clinical services, and negotiating favorable terms. Regular reviews and updates help maintain accuracy, reduce billing discrepancies, and support timely, sustainable reimbursement.

For groups engaged in value-based care, Guidant MSO supports the structuring and management of shared savings, capitation, and bundled payment contracts. We help align contract terms with clinical and financial goals and provide data analytics to track performance metrics such as cost, quality, and patient outcomes. Our services help providers optimize results, reduce risk, and succeed in value-based care arrangements.