Network Contracting & Evaluation

ReimbursementAnalysis™ Solutions

ReimbursementAnalysis is a detailed, consultative analysis providing a comparison of contracted reimbursement rates for payers. Reden & Anders consultants use ReimbursementAnalysis to provide payers with actionable, competitive financial data for negotiating provider contracts. Using ReimbursementAnalysis helps level the playing field in provider negotiations.

ReimbursementAnalysis can help you:

  • Identify providers with the most opportunity to affect contract negotiations
  • Develop an in-depth knowledge of key providers and let them know you understand their business
  • Validate or contradict assertions made by providers in contract negotiations
  • Identify leverage points to help you move towards best-in-class or market competitive rates

Services & Tools:


Competitor Reimbursement Analysis
Reden & Anders analyzes a payers coordination of benefits (COB) claims to develop in-depth knowledge of key competitors’ reimbursement rates. Experienced Reden & Anders consultants work with payers to extract and document the necessary data points from COB claims and analyze the data to compare their rates to competitor rates at the procedure level. Competitor Reimbursement Analysis can be performed for facilities, physician groups, and professional fees.
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Hospital Financial Analysis
Hospital Financial Analysis uses publicly available financial data and Reden & Anders extensive financial modeling to help a payer understand how their reimbursement rates compare to the rest of the managed care market at a specific facility/system. Hospital Financial Analysis also provides insight as to how much margin a facility/system is earning or losing on your specific contract and the various payer groups (government, self-pay, and total managed care).
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Market Reimbursement Analysis
Reden & Anders analyzes our own database of claims consisting of more than 5 million covered lives to identify market-specific ranges of average charges and reimbursement rates down to the procedure or procedure category level. Market Reimbursement Analysis can provide valuable claim based gross charge and allowed information for a payer's existing or targeted network markets. Market Reimbursement Analysis can be performed for facilities and physicians.
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