What is managed care contracting and why does it matter?
Managed care contracting is the process of negotiating agreements between healthcare providers and payers such as commercial insurers, Medicare Advantage, and Medicaid managed care organizations. These contracts define reimbursement rates, covered services, and performance metrics. Effective contracting ensures fair payment, improves patient access, and aligns care quality with financial sustainability. At Spartan Consulting Group, we understand the importance of these contracts in the healthcare landscape.
Which payers do you work with?
We negotiate with:
- Commercial insurers (HMO, PPO)
- Medicare Advantage and Medicaid MCOs
- Employer-sponsored and self-funded plans
- Specialty arrangements such as bundled episodes and carve-outs
How long does a typical negotiation take?
Most engagements at Spartan Healthcare take 8–16 months, depending on payer mix, contract complexity, and decision-making timelines. Adding credentialing or network expansion may extend the process slightly.
What information do you need to start?
We typically request:
- Current payer contracts and fee schedules
- Historical claims data or EOBs
- Provider rosters and service lines
- Credentialing status or CAQH profiles
- Performance metrics like denial rates and utilization trends
Do you guarantee a specific percentage increase?
No. Every negotiation is unique. In select cases, clients have achieved as high as 50% increases on certain contracts, but results vary by payer type, market, and scope. At Spartan Organization, we focus on sustainable improvements and transparency—not unrealistic promises.
What is credentialing and why is it important?
Credentialing verifies a provider’s qualifications and compliance with payer standards. It includes checking licensure, education, certifications, and malpractice history. Without credentialing, providers cannot bill under most managed care plans.
What does your credentialing process include?
Our credentialing services cover:
- Application submission and CAQH management
- Primary source verification
- Coordination with payer credentialing committees
- Re-credentialing every 2–3 years to maintain compliance
Do you handle credentialing nationally?
Yes. We manage credentialing for providers across Florida, Texas, and other U.S. markets, leveraging CAQH and payer-specific workflows for efficiency.
What reimbursement models do you negotiate?
We specialize in:
- Fee-for-service with optimized fee schedules
- Capitation and PMPM arrangements
- Gainshare and value-based contracts tied to quality metrics
- Bundled and episodic payment models
Do you provide tools to monitor performance after implementation?
Yes. We offer:
- Payer-specific performance scorecards
- Forecast dashboards for financial impact
- Quarterly reviews with actionable insights
Can you assist with workers’ compensation or repricing networks?
Absolutely. We integrate managed care contracting expertise with workers’ compensation repricing strategies, optimizing access and reimbursement for complex networks.
How do you ensure compliance and trust?
We follow strict HIPAA protocols, maintain transparent workflows, and apply industry best practices. Our approach aligns with Google’s E‑E‑A‑T principles—showing experience, expertise, and trustworthiness through documented processes and anonymized case studies.
What are the next steps to get started?
Share preliminary data (contracts, claims, provider rosters)
Schedule a discovery call to define goals
Receive a customized proposal with timeline and scope
Begin contracting, credentialing, and implementation
Contact us: Schedule a Consultation