Payer Contracting Playbook

Effective payer contracting is foundational to a medical practice’s financial success. These agreements determine the terms under which services are reimbursed, directly impacting cash flow, patient access, and operational viability. Without vigilant oversight and strategic management, practices risk underpayment, missed revenue opportunities, and burdensome administrative errors. As reimbursement models become more complex and payers increasingly adopt value-based terms, practices must evolve from reactive to proactive contract management.

MGMA’s Payer Contracting Playbook equips you with a structured, step-by-step framework for managing the full lifecycle of payer contracts — from initial request and evaluation to negotiation, implementation, and renewal. Built around best practices and informed by subject matter experts, the playbook includes guidance on legal reviews, reimbursement modeling, credentialing, compliance, and dispute resolution. It also features MGMA’s best member-exclusive tools, including a Payer Contracting Glossary, credentialing checklist, and links to deeper dives into building your payer contracting skills. 

As you keep a close eye on reimbursement and payer mix shifts, this playbook helps ensure contracts are not only competitive but also aligned with your strategic goals and long-term financial health.