Payer Contracts: Looking Forward to 2025 

We blinked and it is November already. Holy Smokes! We are deep into the fourth quarter of 2024 and you are probably preparing for the holidays and wrapping up year-end projects. As we celebrate the end of the year, it is important to also look ahead and lay the groundwork for success in 2025.  

Contract Renegotiations 

Understanding your agreements and your patient population will be instrumental to successful contract renegotiations in 2025. Once your agreement has met its initial term, you can approach the payers to discuss renegotiations; start this process ahead of your anniversary date to give yourself and the payer adequate time. In January, catalog your agreements and map out when you can reach out to the plans. While preparing for renegotiations gather how many visits you have had with members of a specific payer and notate what sets you apart from your competitors. It is important to know what your cost per visit is and to approach the payer with a clear vision of where you want to go. Consider your online reviews, hours of operation and ancillary services when preparing your proposal. Typically, BCBS, Medicare, Medicaid and Tricare will not consider renegotiating; additionally, Managed Medicare and Managed Medicaid plans rarely reimburse over 100% of the current state fee schedule.  

Updated Documentation 

Often the payers will require updated documents to maintain your participation. Keeping updated files for your providers and your entity will set you up for success as you receive payer recredentialing notices. Licenses, board certifications, certificates of insurance, CLIA certificates, business licenses and W-9s are all examples of documents that have expiration dates or need to be updated annually. Going into 2025, review your files and set reminders ahead of any expiration dates. Planning ahead and having complete files allows you to be ready for whatever requests come your way. It is important to update each provider’s profile with the Council for Affordable Quality Healthcare (CAQH) to reflect their new documents, this ensures that payers who use this platform have current information. Ensuring that your credentialing vendor has updated records will help them complete any future credentialing or recredentialing applications without delay.  

Recredentialing 

Each payer has their own timeframe and process for recredentialing your providers or your facility. Knowing each payer’s credentialing requirements, your provider or facility’s effective dates and each payer’s recredentialing processes will help you be prepared in 2025. Recredentialing requests can come via e-mail or regular mail, sometimes these will come to your clinic, to the provider themselves or to your credentialing vendor. During the pandemic, some payers paused their recredentialing processes; since the end of the public health crisis, payers have started to move forward with recredentialing efforts again – it is important to confirm if your payers have reinstituted these processes and understand when recredentialing is due. Missing a recredentialing date can have major impacts to your practice – everything to lost revenue, notifications to members that a provider is no longer in network or the timeframe that a provider is out of network while they go through the credentialing process again.  

Spending a little bit of time in preparation will help you have a fruitful 2025. Wishing you all of the successes in the New Year!