Payer Contracts Change. Does Your Team Know When They Do?

Reimbursement rates, prior authorization requirements, and billing policies shift — often with minimal notice. If your billing team is working from last year's rules, you're filing claims into requirements that have already moved.

Common areas where practices get caught off guard:

• - PA requirements added to previously exempt procedures
• - Drug formulary changes affecting medication billing
• - Network adequacy changes affecting in-network status
• - Claims submission format updates

The answer isn't memorizing every payer's rules. It's having a system to monitor changes and update your billing workflow when they happen.

When was the last time you reviewed your top payer contracts?