Revenue Starts With Your Contracts. We Make Sure They Work for Your Business.
Most providers never revisit their payer contracts until there’s a problem: low rates, underpayments, hidden carve-outs, long delays, or denied claims with no appeal path. But by then, the damage is already done.
At Align, we approach payer strategy the same way we approach operations: systematically, aggressively, and with full visibility.
We help behavioral health providers and PE-backed platforms evaluate their current contracts, understand reimbursement trends, clean up payer relationships, and renegotiate from a position of clarity and control. Whether you’re out of network and considering a shift, or in network and feeling stuck, we’ll help you design a strategy that fits your business model and goals.
Most Payer Problems Are Built Into the System
It’s not just about bad rates. It’s about unclear expectations, inconsistent execution, and poor data visibility.
If you’re seeing any of the following, you likely have a contracting or strategy issue:
- Significant variation in reimbursement by payer or facility
- Rates that don’t align with your level of care or acuity
- Payers demanding documentation that isn’t captured in your workflow
- Contracts missing critical terms like unit definitions or timely filing language
- Inconsistent authorization practices across the same payer
- Denials that stem from misunderstanding contract language
- SCA processes that are manual, delayed, or not tracked at all
These issues lead to revenue leakage, cash flow volatility, and operational dysfunction. We identify and fix them.
Our Approach to Payer Strategy
1. Conduct a Contract Audit
We review your current agreements, rate sheets, amendments, carve-outs, and effective dates. We flag gaps, outdated terms, missing addenda, and conflicting language.
2. Map Current Reimbursement Performance
Using your billing data, we build a payer matrix that shows what you’re actually collecting by level of care, diagnosis, and geography. This becomes the foundation for any negotiation or restructuring.
3. Build a Strategic Plan by Payer
Not all payers should be treated equally. We help you segment by performance, volume, and strategic value. Then we recommend which relationships to maintain, renegotiate, exit, or push for SCAs.
4. Improve Internal Execution
Strong contracts mean nothing if your team doesn’t follow the workflows they require. We ensure your admissions, UR, and billing teams are aligned with contract terms and trained to execute consistently.
5. Support Negotiations and Communication
We don’t just write talking points. We lead the conversation. That includes scripting, data prep, outreach to reps, and renegotiation support. If needed, we’ll handle it directly.
We Also Support
- SCA process optimization and tracking
- Documentation templates aligned with payer requirements
- Payer issue logs and resolution tracking
- Internal contract repository setup and naming conventions
- Credentialing oversight and payer engagement coordination
- Modeling in-network vs out-of-network scenarios
- Support during due diligence or transaction prep
If You Don’t Understand Your Contracts, You’re Not in Control
Most facilities underestimate how much money and risk is tied up in payer relationships.
We help you bring those dynamics out of the shadows and build a strategy that puts your team in control of reimbursement, not at the mercy of it.