Description
Protecting Revenue Through Network Participation Alignment
Your organization may have contracts with multiple insurance payers, but are you certain those agreements cover every product and service line you’re billing?
Many behavioral health organizations assume that being in-network with a payer means they are automatically participating in all of that payer’s products. However, network participation can vary across Commercial, Marketplace, Medicare Advantage, and Medicaid plans.
When payer agreements, product participation, and clinician credentialing are not properly aligned, organizations may face avoidable claim denials, delayed reimbursement, and lost revenue.
Our Product Line & Network Alignment Review helps behavioral health organizations identify these gaps, understand their potential financial exposure, and take proactive steps to protect reimbursement.
What Does the Review Include?
Our review evaluates five key areas of network participation:
- Payer Participation Agreements: Review executed payer contracts to identify which products and service lines are included under each agreement.
- Product Line Analysis: Evaluate Commercial, Marketplace, Medicare Advantage, and Medicaid participation against your organization’s billing activity.
- Clinician Credentialing Verification: Verify individual clinician credentialing status for the payer products your organization bills.
- Group & Facility Network Participation: Review group and facility-level enrollment to identify potential participation gaps.
- Risk Identification: Identify potential billing and reimbursement risks associated with network misalignment.
What You’ll Receive
The review includes:
- Evaluation of up to 10 payers
- Review of up to 20 clinicians
- Written findings report identifying participation gaps
- Risk assessment outlining potential reimbursement concerns
- Practical recommendations to address identified issues
- One-hour consultation to discuss findings and next steps
Investment
$995 Flat Fee
Additional review options:
- Additional clinicians: $20 each
- Additional payers: $75 each
Why Network Alignment Matters
Network participation is more than having a signed payer contract. It requires alignment between your organization’s agreements, the products being billed, and the clinicians delivering services.
Identifying discrepancies before they become recurring revenue cycle problems can help your organization make more informed operational decisions and reduce avoidable reimbursement risks.
Know where your organization stands before a network participation issue affects your revenue.
Request your Product Line & Network Alignment Review today.
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