Align executes payer contracting and contracting operations as a revenue strategy, not a paperwork exercise. We build a disciplined contracting engine that improves reimbursement, expands access, reduces authorization friction, and creates a scalable contract repository and workflow that leadership can govern. The outcome is simple: better rates, cleaner workflows, faster decisions, and fewer surprises.
Who this is for
- Programs operating out-of-network or living on single case agreements (SCAs) that need a scalable contracting path.
- Facilities with inconsistent rates, unclear contract terms, and no centralized contract management.
- Operators seeing payer behavior that does not match the contract (underpayments, denials, “silent” policy changes).
- Teams preparing for an exit that need investor-grade contract visibility and risk control.
The problem we solve (direct)
Most organizations lose money in contracting because:
- Contracting is fragmented across multiple people with no single owner or tracking system.
- Rate discussions happen without a real model, so negotiations are emotional and weak.
- Contract terms are signed without operational review, creating downstream UR and billing failures.
- There is no contract repository, renewal calendar, or compliance workflow,so the organization “discovers” problems after revenue is lost.
Align turns contracting into a governed operating system.
What Align delivers
1) Contracting Strategy and Targeting
- Prioritized payer target list aligned to geography, level of care, and payer mix goals
- In-network vs OON vs SCA strategy with clear tradeoffs (volume, margin, risk, timeline)
- Network expansion roadmap and sequencing plan (what first, what later, why)
- Credentialing alignment where needed to ensure contracts can actually activate
2) Contracting Operations Build (System + Workflow)
- Centralized contract repository design (naming conventions, version control, access rules)
- Contract tracker: payer status, rep contacts, submission dates, follow-ups, expirations, renewal cycles
- Standard contracting workflow: intake → negotiation → approvals → signature → implementation → monitoring
- Clear roles and handoffs between admissions, finance, UR, and billing
3) Financial Modeling and Negotiation Support
- Reimbursement modeling by LOC and payer scenario (per diem, case rate, fee schedule, carve-outs)
- Margin and break-even analysis to establish negotiation floors and “walk-away” terms
- Negotiation prep packs: positioning, comps, quality story, access needs, and market dynamics
- Documentation requirements and UR readiness aligned to what payers actually authorize
4) Single Case Agreement (SCA) Systemization
- SCA templates and playbooks where contracting is not immediately feasible
- Rate matrix and standardized SCA request logic
- Expiration tracking, re-auth workflow, and communication protocols
- Closed-loop coordination with admissions and UR to prevent gaps and denials
5) Contract Performance Monitoring and Underpayment Controls
- Post-contract implementation checklist to ensure rates load correctly and billing follows terms
- Underpayment detection process and reconciliation workflow
- Denial trend reviews tied back to contract language, documentation, and UR process
- Renewal and renegotiation calendar with performance evidence ready in advance
Execution approach (phased)
Phase 1: Baseline + Audit (Weeks 1–3)
- Inventory current contracts, rates, and payer behavior
- Identify gaps: missing contracts, unclear terms, underpayments, operational risk
- Build target list and contracting roadmap
Phase 2: Build the Contracting Engine (Weeks 4–8)
- Repository, tracking, workflow design, and role clarity
- SCA systemization (if needed)
- Negotiation model and documentation/UR alignment
Phase 3: Execute + Optimize (Weeks 9–16+)
- Active outreach, negotiations, follow-ups, and payer management cadence
- Implementation verification and ongoing monitoring
- Renewal/renegotiation schedule and continuous improvement
Signature deliverables
- Payer Target List + Contracting Roadmap (sequenced plan)
- Contract Repository + Naming/Version Standards
- Contract Tracker Dashboard (status, contacts, timelines, expirations, next actions)
- Rate Matrix (by LOC, payer, region; aligned to margin floors)
- Negotiation Prep Packs (one per target payer)
- SCA Playbook + Templates (request logic, tracking, renewal cadence)
- Contract Monitoring Framework (underpayments, denials, compliance controls)
Outcome language you can reuse
- “We turn contracting into a managed revenue strategy with governance and visibility.”
- “We improve reimbursement and reduce surprises by aligning contract terms to operational reality.”
- “We build a repeatable system for SCAs, renewals, and payer follow-up.”
- “We protect margin by detecting underpayments and enforcing contract terms.”
What makes Align different
Most contracting support is tactical and reactive. Align is strategic and operational:
- Negotiations grounded in financial modeling and payer reality
- Workflow and repository systems that prevent contract chaos
- Ongoing monitoring to ensure contracts perform as intended
- Tight integration with admissions, UR, and billing so revenue is actually captured