Getting started with Payer Contract Lifecycle Management

Payer Contract Lifecycle Management keeps your payer contracts, amendments and fee schedules in one place, with the terms modeled so they can be calculated. It compares what each payer actually paid on every remittance with what the contract says it should have paid, and turns the variances into worklists for appeals and payer follow-up. It also tracks renewal and notice dates, so negotiations start from evidence rather than from the calendar.

What it is for

Payer contracts are negotiated once, filed as PDFs, and then rarely consulted. Fee schedules change by amendment, carve-outs and escalators are buried in exhibits, and the expected reimbursement loaded in the billing system drifts from what was signed. Underpayments are spotted only when someone happens to notice, appeal deadlines pass, and renewal notices arrive with no clear picture of how the payer has performed under the current terms.

• Contracts, amendments and fee schedules sit in different places and versions
• Expected reimbursement in the billing system does not match the signed terms
• Underpayments are found by chance and appeal windows are missed
• Renegotiations start without evidence of how each payer actually paid

Who uses it

• Managed care and payer contracting teams at hospitals, health systems and physician groups
• Revenue cycle leaders who answer for net revenue
• Underpayment and denial analysts who work variances and appeals
• Finance teams who model contract changes and reserves
• Compliance staff who oversee overpayment identification and refunds

Before you start

• Your organization licenses Payer Contract Lifecycle Management from Moraph.
• A Moraph client account in that organization, signed in.
• Access to Payer Contract Lifecycle Management in Moraph Apps, given by an administrator in the Moraph Portal under People and access.
• For setup: the product administrator role.

Steps to get started

1. Sign in at app.moraph.com with your Moraph account.

2. Open Payer Contract Lifecycle Management from the launcher. The first time anyone opens it, its workspace is created from the default described in Workspace reference.

3. Check your role: what you can see and do depends on it. See Roles and permissions.

4. Product administrators: work through Set up Payer Contract Lifecycle Management before your team starts.

5. Everyone else: start with Everyday tasks.

Where to go next

• Set up Payer Contract Lifecycle Management
• Everyday tasks
• Connect your systems
• Security, data and compliance
• Troubleshooting and the support guide
• Product overview on moraph.com