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Monida's payer contracting services are one of the main reasons providers join Monida. As a member, you have the ability to participate in payer contracts without having to go through the entire contracting process on your own. We secure contracts for our members to participate with insurance companies, third-party payers and preferred provider organizations. We negotiate the non-financial terms of contracts, focusing on the other issues that are important to providers such as elimination of silent PPO provisions, inclusion of prompt payment clauses, appropriate language defining "emergency" and "medical necessity," appropriate termination and amendment language and establishment of language determining how codes will be adjudicated.
By negotiating the language as a group, we reduce providers' costs of contracting and payers' costs of putting together a network of participating providers. We recognize that contract participation is important in helping reduce out-of-pocket costs for patients, and we also recognize that the provisions of the contract must not place overly burdensome administrative responsibilities on our providers, must assure that providers are paid for the services they provide and must assure that patients have access to the services they need.
By negotiating the non-financial terms as a group, we prevent each of our members from having to take time from their practice or facility to negotiate an individual contract. While working to secure a contract, Monida retains legal advice as necessary, helping reduce the necessity for each provider to hire an attorney. However, we are not the exclusive contracting entity for any of our members - each provider retains the right to negotiate a contract directly with a payer or to obtain legal advice.
Although we do not negotiate the payment terms of contracts, we are still able to commit the network to participate in a contract. In order to expedite the contracting process, members authorize Monida to sign them up to participate in contracts that meet their individually determined acceptable rates. Once the contract is complete, we will sign up those providers whose authorization meets the financial terms of the contract. In the event the payer's proposed rates do not satisfy a member's authorization terms with Monida, we will send the member a note inquiring whether or not they wish to participate at the rates proposed by the payer.
Once the contract is in place, Monida offers a second significant benefit to our members - contract management services. By virtue of membership, members can contact Monida to assist them in any matter having to do with one of our contracts or subsequent reimbursement. We hire full-time staff to assist in the on-going management of the contracts, to ensure that our members' claims are adjudicated correctly. We don't just sign you up and assume everything will function according to the contract - we are here to assist you when you have difficulty with any Monida contracted payer.
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