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Key takeaways: Revenue cycle teams need contract modeling tools that keep pace with changing reimbursement methods and payer rules. Returning to Experian Health’s Contract Manager and Contract Analysis gave Prevea Health greater confidence in its reimbursement analysis, helping staff identify underpayments earlier and investigate payment variances more efficiently. The changes delivered measurable results, including more than $323,000 recovered per quarter from key procedure codes, a 50% reduction in manual audit time, faster payments and fewer days in accounts receivable. Challenge: Changing reimbursement rules put contract modeling to the test Revenue cycle teams rely on accurate contract models to determine how much they should be paid for each claim and to confirm that payments match the agreed terms. Maintaining these models is increasingly challenging as organizations handle hundreds of agreements with different reimbursement methods and frequently changing payer rules. Prevea Health experienced this firsthand. Processing up to 100,000 claims each month, the organization’s reimbursement analysis had become more demanding. The team needed more flexibility and visibility to help them model complex payment scenarios, simplify contract maintenance and calculate expected reimbursement with greater confidence. “Our modeling needs grew more complex, and we needed clearer visibility into our results and greater certainty in the outputs. That’s when we recognized how much we had relied on the precision, flexibility and clarity of Contract Manager and Contract Analysis to have confidence in the accuracy of our numbers.”Tony Walch, Revenue and Reimbursement Analyst at Prevea Health Solution: Contract modeling designed for precision, flexibility and clarity Prevea Health had successfully used Experian Health’s Contract Manager and Contract Analysis for many years before management changes prompted the organization to move contract performance work into Epic®. It soon became clear that those previous capabilities were needed again. Returning to Contract Manager and Contract Analysis gave the team a more reliable way to compare expected and actual reimbursement, investigate payment variances and identify underpayments. Multiple payer contracts could be modeled in one place, and advanced reporting tools allowed staff to filter and analyze real claims data to understand the financial impact of new payer requirements. The team could drill down to individual procedure codes to understand how different payer contracts reimbursed similar services in different departments. Implementation was structured to avoid interrupting the team’s day-to-day reimbursement analysis. Maintaining contract models using this approach would also be less resource-intensive. Experian Health analysts updated the contract logic to reflect changes such as Medicare base years, Geographic Practice Cost Index (GPCI) updates and payer-specific reimbursement rules, helping improve accuracy without adding work for the team. Outcome: Better reimbursement analysis pays off Faster payments, fewer appeals and less time on follow-up Contract Manager and Contract Analysis gave Prevea Health the precision, flexibility and clarity they were looking for. Earlier identification of underpayments meant recoveries could begin sooner, while fewer payment discrepancies reached the appeals stage. Staff spent less time on manual audits and follow-up, payments moved through the revenue cycle more quickly and days in accounts receivable fell. This translated into measurable operational and financial improvements. Key results:– More than $323k recovered per quarter from key procedure codes – 50% reduction in manual audit time – Sustained improvement in payment variances – Faster payments and fewer days in accounts receivable Better analysis leads to better decisions For Walch, two capabilities made the biggest difference: a powerful modeling engine for testing different reimbursement scenarios and reporting tools that showed where revenue was being lost and where action was needed. Variance monitoring highlighted payment discrepancies early, so issues could be resolved before they affected revenue. “Even a small variance in modeling can have a significant impact,” said Walch. “Every undercharge we catch is revenue recovered and insight gained. It reflects how undercharge reporting revealed missed revenue, supported proactive corrections and improved long-term contract optimization, helping us stay ahead of issues rather than react to them.” With greater confidence in their financial analysis, staff could apply the insights to other revenue cycle initiatives. This included charge master optimization and identifying claims reimbursed under “lesser of” payment rules. Prevea Health’s renewed focus on accurate modeling and reimbursement visibility delivered clear operational and financial gains. Procedure code analysis became an ongoing tool for improving contract performance and budget planning. Undercharge reporting produced significant returns. Together, these tools continue to build a reliable foundation for greater financial decisions and better long-term performance. Learn how Contract Manager and Contract Analysis, ranked #1 Best in KLAS for Contract Management, helps healthcare organizations strengthen reimbursement analysis, recover underpayments and improve financial performance. Learn more Contact us Complete the form below to be connected with a member of our Sales team. For Customer Support, including password resets, please visit our Support page.
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Experian Health is very pleased to announce that we’ve ranked #1 in the 2025 Best in KLAS: Software & Services report, for our Contract Manager and Contract Analysis product, for the third consecutive year. Contract Manager, when paired with Contract Analysis, empowers healthcare providers by ensuring payers comply with contract terms, identifying and recovering underpayments, and arming them with real claims data to negotiate contracts. This enables providers to negotiate more favorable terms and maintain financial stability. Clarissa Riggins, Chief Product Officer at Experian Health, says, “In the ever-evolving healthcare landscape, our Contract Manager solution has once again been recognized as the #1 Revenue Cycle Management tool by KLAS for the third consecutive year. This prestigious ranking underscores the significant value our solution delivers to our clients by identifying underpayments and facilitating revenue recovery. We are honored to continue supporting our clients with innovative solutions that drive financial success and operational efficiency.” Learn more about how Contract Manager and Contract Analysis can help your healthcare organization validate reimbursement accuracy, recover underpayments and boost revenue. Learn more Contact us
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Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos.
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