PrimeCare News

Monday, December 30, 2013

Contract Update Project: Who’s on First?

With all the mergers, buyouts, shut downs and our long term provider relations contacts moving around or experiencing lay offs, PrimeCare has “laid low” over the past couple of years with regards to updating our contracts. The reason for this is that we have many contracts that were negotiated prior to the extreme downward pressure on reimbursement rates. I have not wanted to bring attention to this, as we have not wanted to initiate a re-negotiation of terms and reimbursements, as they are likely going to be terms that we are less happy with than the status quo.

However, as we go into 2014, there is not going to be any way to avoid going through the updating process, in particular with the MCOs that have changed hands, such as Coventry, for example.  My goal will be protecting the reimbursement rates that we have enjoyed over the last decade and I will do the very best I can to make that happen.

The good news in all of this is that one of our largest contracts, Multi-Plan/PHCS is buying up other plans, regionally and nationally, and at the present time we are not going to have to re-negotiate with them. I will be sending all provider members the updates by the end of January, along with a status report on Multiplan and their list of acquisitions.

Please feel free to contact me with any questions you have about this process.