Rank payer contracts by modeled economic value after rate, denial assumptions, payment timing, and outlier exposure -- so negotiation effort targets where contracts are truly underperforming.
ⓘ Strategic contract-prioritization prototype. Not a contract valuation engine
Starting assumptions — apply to all payers; override in contract detail row per payer
Adjust these to match your facility's baseline. Expand any payer row to override individual contract terms. Overridden fields are highlighted blue.
Modeled payer portfolio
Payer
Reimbursement basis
Vol/yr
Cur rate
Target / proposed
Contract denial %
RCM denial %
Carveout $
Days-to-pay
Click the ⌄ chevron on any row to expand contract detail and override individual terms. Overridden fields turn blue.
Rate = $/day for per diem; $/admission for DRG (approximate — true DRG modeling requires CMI and MS-DRG weights). Medicare (IPPS) is paid per admission via the Inpatient Prospective Payment System: DRG-based, administratively set by CMS, included as benchmark. Medicaid State Plan reimbursement methodology varies by state. Per diem shown here reflects common behavioral health and long-term care structures; acute care Medicaid may use APR-DRG or other state-specific methodologies. Target / proposed rate represents a modeling assumption for administratively set payers.
Results
Payer analysis - modeled economic value
Payer
Basis
Current PV
Proposed PV
Net impact
Contract denial drag (current)
RCM denial drag (current)
Outlier exp.
Contracting priority
Present value (PV) = net revenue × 1/(1 + daily discount rate × days-to-pay). Simple time-value proxy -- not a full cash-flow model.
Contract denial drag (current) = unrecovered revenue from payer-behavioral denials under current contract terms: auth requirements, contract term disputes, level-of-care challenges. Reflects current-period leakage. Not modeled under proposed terms. Negotiable at the contract table.
RCM denial drag (current) = unrecovered revenue from internal execution failures: documentation gaps, coding errors, timely filing. Current-period leakage: operational fix, not a contract fix. HFMA benchmarks: 5–10% avg denial rate; <5% optimal; 85% resolution within 30 days as target.
Note: contract and RCM denials are modeled as additive and independent. In practice some denial categories overlap or interact operationally.
Modeled outlier exposure = vol × outlier rate × max(0, avg total case cost − threshold) × provider share. Approximation only -- Medicare uses fixed-loss thresholds, CCRs, and marginal payment factors.
Contracting priority = weighted score combining dollar impact magnitude, contract denial burden, payment timing, and outlier exposure. Higher dollar impact carries more weight. Not a final contracting algorithm.
Net impact waterfall
Uncompensated care reference not a negotiated contract
Self-pay and charity care reflect uncompensated care burden and broader safety-net reimbursement context -- analytically distinct from payer contract negotiations.
Inflection Health Partners · Payer Contract Scenario Modeler v10 · Strategic contract-prioritization prototype. Not a contract valuation engine