How to Collaborate With Payers in 2025: Advice from HFMA

CFOs can get ahead with payers by using tech, leveraging data, and planning early.

Payers, unsurprisingly, were the subject of much of the talk at HFMA this year. Several sessions focused on the best strategies to keep pace with, or get ahead of payers, including using technology, leveraging transparency data, and reevaluating coding practices to combat denials.

Use tech, but don't wield it as a weapon.

Many health systems are experimenting with AI, particularly for AI generated appeal letters to quickly combat denials. After identifying the system's largest payer, CFOs can work with their teams to identify the service line that is best for automation. One session with Carle Health System Director of Patient Access

Jeana Sherry, lingered on the question "Where can we move the quickest?" when thinking about automation.

Keep in mind, automation isn't all or nothing, ; systems can always start small. While AI is a valuable tools for providers, executives urged each other to not stray too far from genuine, transparent collaboration.

Leverage Data

Providers typically have access to far more data than they use, and with new price transparency rules, payers are now required to display their pricing data. Ensure there is a team and cadence in place to review the massive payer datasets in order to leverage the data in negotiations.

In a session titled: ‘Data-Driven Denial Prevention,' executives from Colorado Children's Hospital outlined the system's initiative to use data-driven decision-making in a comprehensive denial prevention strategy. They urged providers to create a path for easy data visualization. To do this, finance teams can focus on identifying the root cause of denials, (focus on the cause, not the symptoms), analyze that cause, and then trial a solution.

Another session, titled ‘Prescriptive Partnerships: Strategies to Reduce Payer-Provider Abrasion,' with revenue cycle executives from OhioHealth and Baptist Health, urged providers to explore how they can work to co-develop claims editing criteria with payers. Consistent, structured collaboration with payers is key here to building a sustainable formula for managing claims.

Evaluate coding practices

Don't overlook coding practices when managing denials, especially when entering value-based care agreements. One session found that the impacts of Z codes for SDoH data are especially useful, although often overlooked by providers.

As value-based care agreements are increasing throughout the industry, health plans want SDoH data to bolster these agreements. The session discussed how providers need to compile SDoH data better to include in claims. To get a jump on this, CFOs can work with their revenue cycle teams to implement SDoH screening tools.

Start Early, Build a Strategy

Negotiations often fall apart when providers do not work as a synergistic team from the beginning. Identify and define a strategy early on so all leadership is on the same page to avoid later fumbles in payer negotiations.

Start by bringing together a cross-functional team (revenue cycle leaders, contracting managers, clinical leadership, and data analysts) well in advance of any negotiation window. Align this team on key goals: whether it's narrowing down top pain points with a specific payer, identifying problematic denial codes, or highlighting underpaid services that need attention.

Don't wait for contract expiration to begin preparing. CFOs can lead the plan by setting calendar milestones at least six to 12 months in advance to build a layered strategy that incorporates analytics, clinical insights, and regulatory changes.