NEW REPORT: The State of CLM and AI-Powered Contract Intelligence

Why Contracts Are Critical to Streamlining Payer/Provider Collaboration

By Jennifer Conner

In today's hypercompetitive and turbulent healthcare industry, healthcare insurance and payer companies are constantly faced with decisions about how to update and transform their processes to maximize speed, efficiency, and compliance.

Efficient payer/provider collaboration lies at the heart of this challenge. Since network provider ecosystems are built on contracts, payer/provider relationships require ongoing maintenance and documentation to maintain accuracy and compliance—for example, plan-specific exhibits such as compensation and fee schedules. These critical business artifacts must tie directly to the contract—the foundational document of the relationship. However, payers and providers often do not have quick and easy access to these master documents or the ability to associate documentation against them.

Without the ability to self-service and update contract information electronically, organizations must devote resources to work in an unstructured, ad-hoc, back-and-forth manner to communicate—accruing material opportunity costs and taking their teams off the task of facilitating member access to outstanding patient care. As insurance companies contract with more and more physician groups and hospitals that operate under the payer's network, potential failure points can multiply exponentially. These inefficiencies impact not only the contracting team but the very mission of an organization.

Contract Lifecycle Management Software: The Key to Streamlined Payer and Provider Collaboration

The good news is that the converse is also true: Improved contracting processes directly enhance the performance of the payer/provider relationship.

The AI-powered Icertis Contract Intelligence (ICI) platform enables payers to streamline communication and document management throughout the payer/provider ecosystem. By bringing contract communication and documentation into the cloud, all stakeholders operate in real-time from a single source of truth, improving speed and efficiency in all collaboration.

The ICI for Healthcare Payers solution has been tailored with industry-specific functionality, including dynamic exhibit and compensation attachment workflows that enable users to seamlessly self-service plan-specific exhibits, fee schedules, and contracted services requirements linking back to comprehensive contract containers.

By streamlining communication throughout the payer/provider ecosystem, organizations can accelerate contract-writing velocity from days to minutes, which translates to savings and time focused on what matters most for members and patients. Meanwhile, real-time updates with constantly refreshed data, accessible via customizable reports, help payers keep a finger on the pulse of their provider network, providing the information they need to keep those relationships healthy and productive.

ICI enables healthcare payers to move faster, realize value, and reduce risk—pushing beyond contract management and into contract intelligence.

Digital Transformation and the Future of Healthcare

The ongoing digital transformation will reshape how healthcare organizations do business in the years to come. As such, there is simply no longer any place for manual or fragmented contract management systems and processes in a modern healthcare organization. Provider agreements define what services are being contracted, what fee schedules are associated with those services, what requirements must be complied with across a wide range of areas, and performance expectations associated with provider participation in the network. Contracting with this complex array poses never-ending challenges.

With contract intelligence from Icertis, payers can quickly overcome this long-intractable problem, allowing organizations in the health insurance sector to respond to expanding networks and coverage needs quickly and easily and drive speed, performance, and compliance into all their business interactions and relationships—while also structuring contracts and connecting the information in those contracts to surface performance data that can keep their companies out in front, now and into the future.