Relationship Management
We manage your day-to-day payer communication and escalations, providing dedicated support beyond transactional work.
Orthopaedics
Orthopaedic Payer Strategy & Negotiation Experts
We help orthopedic groups secure fair reimbursement and operational relief through data-driven payer negotiation.
$1B+
In negotiated financial lift
12%
Average revenue lift
7-12x
Average ROI
About us
The Nation's Leading Experts in Payer/Provider Contract Negotiations
We are a relationship-driven consulting firm focused on payer/provider innovation, in-depth market analyses that drive sustainability, and long-term results for our clients.
We bring deep expertise in surgical rate leverage, procedural mix, and ASC economics—helping orthopedic groups capture the upside in their contracts.
Our services
We Manage Your Payer Relationships End-to-End
Our services holistically examine every opportunity for improved reimbursement and market access.
Contract Modeling
We provide data-driven financial modeling for every payer contract, so you know the impact before you sign.
Payer Transparency Insight
Clear benchmarking shows exactly how your rates compare to the market, revealing negotiation opportunities and leverage.
Claims Data & Analytics
Identifying underpayments, trends, and revenue gaps lets us recover your lost dollars and strengthen negotiations.
Contract Management
We proactively track renewals and amendments, and identify any recoverable dollars tied to denials.
Dispute Resolution
We handle end-to-end management of payer disputes, driving effective and timely resolution.
Our advantage
We Understand the Challenges Healthcare Organizations Face
Current Landscape
- Missing or fragmented fee schedules undermine negotiation leverage
- Limited market insight into actual payer rates
- Lack of dedicated contracting expertise and payer fluency
- Declining reimbursements and rising costs compress margins
Our Solutions
- Data Diligence We inventory contracts, fee schedules, and amendments to restore complete rate visibility.
- Transparency Analytics We benchmark your rates vs. market to expose negotiation opportunities.
- Specialist Team Expert analysts and negotiators manage payer language, structure, and escalations.
- Revenue & Efficiency Gain Our proven strategies increase practice revenue and reduce administrative burden.
Specialty focus
We Understand the Challenges Affecting Orthopaedics Groups
Surgical & Procedural Rate Leverage
We benchmark surgical and procedural codes to capture the rate upside hiding in your contracts.
ASC & Site-of-Care Economics
We optimize reimbursement across office, ASC, and hospital settings and defend site-of-care choice.
Implant & Device Cost Pressure
We negotiate carve-outs and pass-throughs so implant and device costs don't erode your margin.
Multi-Site Roll-Up Integration
We align payer contracts across acquired sites to standardize rates and protect EBITDA.
Our strategy
Our Proven Model for Your Success
We craft specific payer strategies tailored to your practice, identifying negotiation opportunities and leverage points that strengthen financial and operational outcomes.
1
Understanding Your Market Position
We use transparency data to compare your rates to the market by specialty, geography, CPT code, and payer & product type.
2
Identifying Your Strengths
Every practice has leverage. We highlight yours: quality metrics, access, outcomes, technology, service lines, and patient experience.
3
Building a Go-to-Market Strategy
We tailor your payer strategy, approach health plans, track progress, and model every proposal.
4
Navigating Complex Negotiations
Routine renegotiation or major escalation, we guide you through terminations, payer pushback, and strategic decision-making.
Case studies
Real Results for Orthopaedics Groups
Lancaster Orthopedic Group
Market-Leading Rate Increases
PayrAdvisors realigned commercial contracts to market and supported the group's integration with PSU Health.
+29%
Aetna
Aetna +29%
Capital Blue Cross +16%
Providence +10%
Orthopedic Care Partners
Multi-State Portfolio Optimization
A five-state roll-up with coordinated payer negotiations across major commercial and direct plans.
+$350K
Combined annual lift
Cigna +$155K
UnitedHealthcare +$150K
Partners Direct +$45K
Our timing
What to Expect From Start to Finish
We provide expert guidance and transparent benchmarks to develop a scalable partnership that grows as you grow.
First 60 days
Discovery & Diligence
Review all practice documents, contracts, fee schedules, amendments, W-9s, and benchmark RCM data.
60–90 days
Engagement Kickoff
Execute the Client Services Agreement, BAA, and NDAs, and invoice for services.
60–180 days
Negotiation Begins
Begin the negotiation process and align with you on strategic goals.
6–7 months
Finalize Offers
Review contract language, rate exhibits, and analytics to finalize offers.
8–9 months
Language & Protections
Negotiate contract language that reduces risk and improves administrative challenges.
9+ months
Execution & Loading
Execute contracts, credential providers, and ensure contracts are loaded correctly.
9–12 months
Monitoring
Track and monitor contracts to ensure rate compliance.
18+ months
Continuous Improvement
Begin assessment on renegotiating contracts still below market rates.
Our pricing
We Win When You Win
Our services are paid on our performance. A modest implementation fee keeps barriers low; the rest is earned only when your reimbursement improves.
Our Contingency Model
- Low upfront cost A modest implementation fee reduces financial barriers and accelerates onboarding and contract prep.
- Pay only for results Clients share 50% of the lift only after improved rates are contracted and effective.
Built for Your Structure
- PE-backed portfolios EBITDA-protective performance fee and portfolio-wide scalability.
- Small to mid-size practices Far less risk than outsized retainers of $60–250k per month, with access to high-level expertise.
Are You Ready to Change the Way You Work With Payers?
Schedule a confidential consultation to see what better payer contracts could mean for your orthopaedics group.