Patient access to our services, and getting paid for providing those services, is what the Department of Payer Relations & Contracting is all about. As many of us have experienced firsthand, dealing with the insurance and health plan "rules of the road" can be very challenging. The Payer Relations & Contracting team serves as consultants to the many entities that comprise the University of Maryland Medical System (UMMS) when it comes to medical services contracting, payer relations and staying abreast of marketplace activities that affect our ability to serve our communities and patients.

Serving as part of the UMMS Shared Services Finance team, Payer Relations & Contracting specializes in knowing the people who pay for our services, (Payers, which are known as HMOs, PPOs, insurance companies, third-party administrators, etc.) and facilitating the relationship with those payers operating in our service area, nationally, and internationally, to allow their members to access our services, and in different instances, view our services as preferential.

The team provides payer strategy & medical service contracting support for all UMMS hospitals, physicians, and the many other medical service providers that make up our health system. In addition to contracting for routine services, we also support all specialty services & national/regional Centers of Excellence (COE) designation and risk-contracting that may also require combined physician/hospital arrangements (known here as "Globals" or “bundled services”). Many payers require COE credentialing and in some cases, global contracting, before their members can access our services. Solid Organ Transplantation, Bone Marrow Transplantation, Cardiac Care, Bariatric Surgery & Gamma Knife are a few of our services that can require COE credentialing and global contracting.

The Payer Relations & Contracting team works with physician and hospital leadership to respond to requests for information from the payer community that is used for the ongoing credentialing of our programs and in some cases also utilized for recognizing certain services as a COE. The team provides global risk contract claims administration and accounts receivable management for several national transplant networks such as Aetna, Cigna LifeSource, OptumHealth (formerly United Resource Networks known as URN) and sometimes self-pay patients or foreign governments. This requires understanding how to price our services in a competitive manner and then billing payers or individuals for these services and collecting the money to distribute to our providers. These global contracts require approval and ongoing oversight of the HSCRC (Maryland Health Services Cost Review Commission which regulates hospital rates). Payer Relations & Contracting works with our Finance Department colleagues to obtain approval of these special contracts as well as providing reporting to the HSCRC to maintain compliance.

In addition to actually negotiating contracts, the Payer Relations & Contracting team acts as the conduit and facilitator for payer relationships. This involves cultivating and managing relationships with each major insurer in the Maryland market (commercial, Medicare and Medicaid MCO), and helping our organization understand and operationalize our contractual relationships. From passing along important payer policy or procedural changes that affect our ability to get paid, and representing our health system's interest in our payer relationships and the ever-changing health care marketplace, the Payer Relations & Contracting team is here to serve all areas of our organization.