Our services
Payer contract negotiation and managed care consulting services
Six focused capabilities that strengthen every payer relationship, from first contract review to full network strategy.
Our core service areas
Payer relationship management
Build and maintain strong relationships with payer leadership to drive collaboration, resolve issues, and achieve better outcomes.
- Escalation of claims, credentialing, and policy issues
- Joint operating meetings with payer contacts
- Ongoing account management across your payer portfolio
Contract negotiation
Negotiate competitive reimbursement rates, favorable contract language, and sustainable terms that protect your bottom line.
- Rate proposals backed by market benchmarks
- Review of lesser-of, carve-out, and escalator terms
- Renewal planning and negotiation scenarios
Reimbursement optimization
Identify opportunities to improve reimbursement and payment integrity across commercial, Medicare, and Medicaid programs.
- Fee schedule and underpayment analysis
- High-volume and high-value code review
- Drug and infusion margin analysis by payer
Network and access strategy
Strengthen network position, secure exceptions, and enhance visibility with key payers.
- Network participation and closed-network exceptions
- Site-of-care and member access strategy
- Market expansion planning
Market intelligence and benchmarking
Leverage transparency data and market insights to inform strategy, benchmark performance, and uncover opportunities.
- Negotiated rate benchmarking by payer, code, and geography
- Competitor and peer rate comparisons
- Payer transparency data, powered by PayerPrice
Due diligence and transaction support
Support acquisitions, partnerships, and investments with contract and reimbursement risk assessments.
- Payer contract inventory and assignability review
- Reimbursement risk and upside assessment
- Post-close payer integration planning
Health plans we negotiate with
Each payer type has different contracting levers. We tailor strategy to how each one sets and pays rates.
Commercial plans
National and regional carriers, such as Blue Cross Blue Shield plans and UnitedHealthcare.
Medicare Advantage
MA contracts benchmarked against the Medicare physician fee schedule and local market rates.
Medicaid managed care
Managed Medicaid plans, where network access and state program rules shape the negotiation.
Exchange plans
ACA marketplace products, often with narrower networks and separate rate exhibits.
Who we help
Focused support for specialty organizations navigating payer complexity.
Specialty practices and physician groups
Neurology, orthopedics, dermatology, gastroenterology, urology, and other specialties.
Infusion and home infusion providers
Drug reimbursement, site-of-care, and margin strategy by payer.
ASCs and eye care practices
ASC and physician office contracts, including ophthalmology.
Specialty pharmacies and health IT companies
Network access and payer partnerships for pharmacy and technology models.
Behavioral health organizations
Behavioral health, ABA, and neuropsychiatry rate and access strategy.
Private equity and growth platforms
Contract diligence and payer strategy for acquisitions and multi-site roll-ups.
Why healthcare leaders choose Apex
Experienced leaders
Decades of managed care and payer strategy experience across multiple specialties and 30+ states.
Results focused
We focus on measurable improvements in reimbursement, access, and financial performance.
Collaborative approach
We work alongside your team as a trusted strategic partner and extension of your leadership.
Data informed
We leverage market data, transparency, and real-world insights to drive smarter decisions.
Flexible engagements
Right-sized solutions tailored to your goals, priorities, and resources.
Strategic. Collaborative. Results driven.
Organizations may engage Apex for a one-time assessment, ongoing payer partnership, or both — we meet you where you are and tailor our support to your goals.
One-time assessment
A defined review of your contracts, rates, and market position, with a prioritized list of negotiation opportunities.
Ongoing payer partnership
Continuous contract management, negotiation, reimbursement monitoring, and payer relationship support.
Services FAQ
When should we renegotiate a payer contract?
Start 6–12 months before a renewal or evergreen notice window, or any time benchmarks show your rates are below market. Many contracts renew automatically, so planning early protects your leverage.
What do you need from us to start a contract review?
Current payer agreements and amendments, fee schedules or rate exhibits, and a summary of claims volume by payer and code. We identify any missing schedules as part of the review.
Can you help us get into a closed network?
Yes. Apex has secured network participation exceptions, including UnitedHealthcare exceptions in Florida and Montana, by building an access and quality case for the payer.
Do you support private equity due diligence?
Yes. We assess payer contract terms, reimbursement risk, and upside for acquisitions, partnerships, and investments, then support payer integration after close.