If a major agreement reopens in the next twelve months, this list is the work that has to happen before it does.
The negotiation-prep checklist
The questions you should be able to answer before you sit down with a payer, and where each answer comes from.
Use this whether or not you ever talk to us. Most managed care teams can answer about half of it from memory and the other half only by opening documents. The half you cannot answer quickly is, reliably, the half the payer already knows.
How to use it: take one payer, one renewal, and work down. Mark each line A (answered, with the document behind it), P (partial, meaning you believe it but cannot show it), or N (no answer today). The P lines are your risk. The N lines are your homework.
1. Rate position, where you actually stand
| # | Question | Where the answer lives | Why it matters at the table |
|---|---|---|---|
| 1.1 | What is this payer paying as percent of Medicare, per facility? | Executed rate exhibit, joined to the CMS IPPS file for each CCN | It is the anchor number for the whole conversation. If you and the payer compute it differently, you spend the meeting arguing about arithmetic. |
| 1.2 | Is that number computed the same way for every facility and payer? | Your own method, written down or not | A percent of Medicare that changes depending on who was asked is not usable as leverage. |
| 1.3 | Where does this payer rank against the rest of your own book? | Every other executed agreement, on the same basis | Your best internal comparable is the strongest evidence you own, and it is evidence the payer cannot dispute. |
| 1.4 | Which of your facilities is worst under this payer, and by how much? | Facility-level rate exhibits across the same agreement or its state variants | Multi-state systems routinely find a spread nobody had quantified. |
| 1.5 | What share of your net revenue rides on this single agreement? | Finance, by payer | Determines how much of the negotiation budget this deserves. |
On external comparison: we can tell you how this payer compares to your other payers and to Medicare. Comparing you to other health systems would need a price-transparency feed, which is a different data source. If you need it, plan for a transparency vendor alongside, not instead.
2. The terms behind the rate
| # | Question | Where the answer lives | Why it matters |
|---|---|---|---|
| 2.1 | Is there a lesser-of or billed-charge cap? | Rate basis language in the agreement or exhibit, verbatim | A headline percent of Medicare capped against your chargemaster is not what you collect. In the reference book a rate read 100% of Medicare while the contract said the lesser of 100% of billed charges or 106% of Medicare. |
| 2.2 | Is there an annual escalator, and on what index? | Agreement term or amendment | An escalator compounds across the whole term. Its absence is worth as much to know. |
| 2.3 | If there is no escalator, is that absence confirmed or merely unfound? | A full read of every document for that contract | Blank and absent are different answers, and only one of them is safe to rely on. |
| 2.4 | What is at risk on quality, and what triggers it? | Quality withhold or at-risk provisions | Money you do not collect unless a condition is met, usually documented away from the rate exhibit. |
| 2.5 | What is the timely filing window? | Claims and billing article | Your revenue cycle is being held to it whether or not anyone has read it. |
| 2.6 | What is the overpayment lookback, and the repayment window? | Recovery or audit provisions | Determines how far back the payer can reach and how fast you must pay. |
| 2.7 | Which carve-outs, implants, or high-cost drug provisions apply? | Exhibits and appendices | Frequently the single largest gap between modelled and realised rate. |
3. Control, and who can change what
| # | Question | Where the answer lives | Why it matters |
|---|---|---|---|
| 3.1 | Can this payer change rates without your signature? | Amendment article | In the reference book, 3 of 45 contracts were payer-controlled, so the payer could change rates by letter. |
| 3.2 | Can payer policy override contract terms? | Policy incorporation language | A policy manual that governs by reference can move the deal without an amendment. |
| 3.3 | Where you cannot tell, have you recorded it as unresolved? | Your own record | In the reference book, 10 of 45 were shown as unresolved, because we would not guess. Ten guesses that look like answers are worse than ten open questions. |
| 3.4 | What are your termination rights, and on how many grounds? | Termination article, all versions | In one reference contract, four separate grounds for termination for cause were extracted where the reader had concluded there was one. |
| 3.5 | When does it auto-renew, and what is the notice deadline? | Term and renewal article | This is how a bad rate renews while nobody is looking. |
4. Precedent, and what you already won
| # | Question | Where the answer lives | Why it matters |
|---|---|---|---|
| 4.1 | Which version of this agreement governs today? | The amendment chain, in order | Amendments supersede rates quietly. Quoting a superseded rate at the table is an unforced error. |
| 4.2 | What did you ask for last cycle, and what did you get? | Prior rate versions and negotiation files | Your own precedent, if it is retained. Usually it left with the person who ran it. |
| 4.3 | What did you concede last cycle, and for what? | Same | The payer has this. You should too. |
| 4.4 | Can you show the page behind every number above? | The documents themselves | The moment a number is challenged, an uncited number is worth nothing. |
5. The whole book, beyond one agreement
| # | Question | Why it matters |
|---|---|---|
| 5.1 | Which agreements in the book came in through an acquisition, and has anyone at corporate read them? | Inherited paper is where the surprises are. |
| 5.2 | How many contracts renew in the next four quarters? | Auto-renewal is a deadline you already own. |
| 5.3 | If your lead negotiator left tomorrow, what would the next person be able to reconstruct? | The honest test of whether your book is knowledge or memory. |
Scoring
Count your P and N answers for one payer, and multiply by the number of payers in your book. That number is the size of the reading problem, and it is the reason the abstraction never finishes.
Where Basalt Contracts fits
We answer 1.1 through 4.4 from your own executed documents, with every field cited to a document and page. In the reference book, 10,496 of 10,497 extracted fields carry that citation and 9,462 carry the verbatim quote from the contract. Absences are asserted from a full read, never left blank because a search failed. 1,035 of them.
We do not answer 5.3 for you. That one is organisational, and the checklist is the point: if the answers live only in a person, the book is not knowledge yet.
Prepared by Basalt Contracts. Reference counts are from a live deployment at a 60+ hospital multi-state system and are stated as counts, never as projections for your organisation.
Bring the payer you argue with most
Take twenty minutes and we will read one of your executed agreements while you watch, extract every rate and provision to the page it came from, and put it next to Medicare. Your P and N lines are the agenda.