Payer Strategy Solutions
Experts in Payer Strategies
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.
Why Payer Strategy Solutions?
Lighthouse Lab Services has a history of delivering results that can be counted on.
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.
The Payer Strategy Solutions team also provides reimbursement analysis and assistance with pre-authorizations and interpreting medical policies. With 40 years of industry experience, we have the contacts and ability to generate more revenue for our clients.
Through In-Network Agreements, We Enable Our Clients To:
Increase patient and specimen volume
Build successful relationships with payers
Grow market share
"From 2021 to 2022, my company had the pleasure of working with Burns Consulting (since acquired by Lighthouse Lab Services). During that time, they helped us gain access to several major insurance networks, including prolific contracts with independent regional Blues – agreements we could not obtain on our own. Their ability to home in on the small details to create a value proposition to trumpet the virtues and new technologies of smaller, boutique practices bring insurance network visibility – and leverage their unique relationships with health plans – and sets them apart from their contracting competitors. Lighthouse has brought our company immense value and revenue we would not have realized on our own. I highly recommend Lighthouse and would be glad to discuss their merits and offerings with any interested party in person or over the phone."
Dean Tassone, Eurofins Diatherix Laboratories
"I am not one to give outstanding reviews unless the company/individual working with us is actually extraordinary. Lighthouse has done an incredible job in an incredibly short amount of time. We've already made it in-network with several BCBS plans and others are only weeks away. Qitek Labs will be able to accept specimens from almost any clinic in the state of Georgia within the next 2-3 weeks. We'll be able to take a large number of commercials/Medicare from all other states as well. Again, thank you for your help and great work!"
Zachary Husk, Chief Executive Officer at Qitek Labs
"Lighthouse has been a true ally through the years, battling the slings and arrows of the Pathology world. I can rely on them to keep up with laws and issues we face, while I focus on Pathology and patient care. They provide oversight over our billing office, which sometimes needs prodding. They have my back, and I appreciate the help."
"We partner with Lighthouse because they are always a step ahead. They have strengthened our practice with their knowledge and expertise. We appreciate their dedication and integrity!"
Lucent Pathology Partners
"Our group has used Lighthouse for many years. When we started they did an in depth investigation of our billing process and identified areas where we could make improvements and increase our monthly revenue. They took us through two different RFP processes for billing agencies and helped identify the best match for us. Through all of this they have been knowledgeable, professional, and efficient, displaying integrity by reducing their fee during our lowest months. I highly recommend them."
North Pathology Associates
"We love Lighthouse. Incredible support. Great account management. Superior technical support. We all talk about how great it has been to work with Lighthouse. We cannot say enough positive about the company. "
R. Scott LaNeve, General Manager, Drugscan, Inc.
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.