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Payer Strategy Solutions

Experts in Payer Strategies

Payer Strategy Solutions team at Lighthouse specializes in assisting clinical labs with payer strategies and provides a full suite of managed care contracting and consulting services.

Partnering with medical labs, managed care companies, health systems, and providers, we offer subject matter expertise and insights into in-network credentialing and contracting, strategic planning, managed care contracting, and value-based care contracting.

group of scientists working at the laboratory

Why Payer Strategy Solutions?

Founded by seasoned and experienced health care executives with a combined 40 years in the industry, Payer Strategy Solutions team offers a wide range of managed care consulting services. Whether it is developing go-to-market strategies, advising clients on the current state of the managed care industry, or negotiating payer contracts at favorable pricing, we work in a collaborative and professional manner.

Lighthouse Lab Services has a history of delivering results that can be counted on.

Service Terminology


A provider term that generally represents the process of a provider applying to health insurance companies/payers for participation in their networks. Payer network types include HMO, PPO, POS, EPO, Medicare Advantage, Medicaid, and rental networks, to name a few.


A payer term that generally represents the internal process of reviewing a provider’s credentials against national, standardized protocols and standards, such as those presented by NCQA and URAC. Payers utilize credentialing committees that meet with varying frequencies and are the critical dependency to contracting.


This step occurs following successful credentialing. Once a provider is credentialed, a standard network contract is offered to the provider. Typical reimbursement rates are based upon a fee schedule as a percentage of Medicare.

Service Highlights

Contract review to ensure clients get the best possible rates, as well as efforts to increase reimbursement over the lifetime of the deal, in full regulatory compliance.

Look at your location, test menu, current contracts, and what MACs you’re in. Offer strategic guidance based on your goals.

Leverage many years of industry experience to ensure all applications are given prompt consideration.

We strive to obtain the best rates possible compared to other laboratories of similar size.

Competitive pricing tailored for your specific needs.


What is Medicare Advantage?

Medicare Advantage is a Medicare health insurance plan offered by a private-sector health insurance company. Medicare Advantage health insurance companies offer HMO and PPO products and networks.

Why can some labs not get in-network?

Health insurance companies manage their provider networks in a variety of ways and under different strategies. For example, HMO networks tend to be more limited in the number of providers in-network due to restrictive contracts and network leveraging. PPO networks, on the other hand, typically offer more member and provider choice of which labs to utilize. Some payers simply use a network need criteria standard, while some require the lab to be located within their state or service area. These are just some of the requirements that may restrict a lab’s participation in network.

Can you re-negotiate your contract?

Many first-year contracts are standard network contracts with non-negotiable contract language and reimbursement. However, there may be exceptions based upon unique or complex services provided. Once a lab establishes a solid track record of quality and excellent turnaround times with little to no provider and/or member complaints, it will be in a better position to renegotiate its contract.

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