Contract Management

Evolving CMS guidelines and requirements demand ever-increasing accuracy and efficiency in the contract management process. Additionally, constant industry changes present challenges that Nova excels with staying at the forefront of the latest updates. We utilize highly reliable and proven techniques to ensure our clients can meet the challenges of this ever-changing landscape of healthcare. 

We provide these services in all aspects of Contract Management: 

• Acquisition of New Contracts: Procure fresh or previously unobtainable contracts to maximize the ability to drive census. 

• Renegotiation of Current Rates: Evaluate current contract rates to seek rate increases, as applicable. 

• Start-Up Facilities/New Builds: Review and recommend contracts with the highest impact for us to pursue.

• Cloud-Based Data Management: Retention of contracts and all updates, ensuring easy accessibility. 

• Contract Summary Quick Reference Guide: Each contract is broken down into straightforward pertinent information for staff. 

• Contract Briefings: Notices of contract changes, updates, and completions are given throughout the contract procurement timeline.

Authorization and Case Management

Optimize the value of each referral. Every time. 

If you are navigating a difficult in-network referral, seeking an out-of-network authorization, or carving out a high-cost medication, Nova can provide the necessary support and experience to facilitate a desired outcome. This allows management and staff to focus on maintaining their day-to-day business performance.  

Additionally, Nova works hand in hand with hospital staff to establish and nurture positive relationships, impacting future referrals.

We understand the time-sensitive nature and respond accordingly utilizing clinical peer review with one on one case assessment.    

Difficult In-Network Referrals

• Establishing medical necessity

• Out of state admissions

• Retro-authorization approvals 

Out of Network Authorizations

• Single case agreements

• Supplement out of network authorizations during change of ownership process

• Out of state admissions

• Retro-authorization approvals

• Denial/Appeals

• Data collection for the negotiation process to acquire sought after contracts

High-Cost Medications

• Review of clinical to exercise due diligence for additional high-cost drugs

• In and out of network carve-out

• Prior authorizations when allowed by plan or policy guidelines to lighten staff case load

Contract Negotiation

Leverage Established Relationships

Nova's deep-rooted professional colleagues work together to bridge gaps in healthcare. 

Comparative Analysis 

We capitalize on our data analysis to ensure you remain competitive in a saturated market. 

Tenacious Chutzpah

We work through every possible outcome, leaving no stone unturned. We explore every viable option until a mutually beneficial resolution is agreed upon. 

The easiest way to boost revenue 

Many contracts are left untouched for years without a contractual increase. You deserve to be compensated accordingly and in line to your market value.

Medical Facility Ownership Changes

When you face unprecedented challenges during a change of ownership, our dedicated professionals work side by side to guide you and your staff through the entire process. This can be a very daunting change that many owners and operators are not familiar with. 

Nova Healthcare specializes in many different types of ownership changes. Rest assured, we have every detail covered so you can continue with your day-to-day operations.

Our proven strategy includes: 

• Initial Discover Call

• Create a custom plan of action

• Collaborate with key staff members at the facility level to ensure a smooth authorizations process during this change. Nova's Case Managers are standing by, should you need assistance. 

• Start a delicate notification process with insurance companies to begin contract updates.

• Assure the rates you receive today, are the same rates you receive tomorrow by exclusive contract comparisons. 

• New or updated contractual agreement finalized and enforced. 

• Quick Reference Guides and Briefings circulated to owners, billing and applicable staff. 

Credentialing/Re-Credentialing

Credentialing
Facility or provider credentialing can take up a massive amount of your time. Nova has credentialing specialists who are ready to:  

• Collect & manage documents

• Compile and assemble applications

• Submit forms for network access

• Record retention for data management

All while adhering to strict submission guidelines and deadlines.

Re-credentialing
Approximately, every three years, re-credentialing will occur. Nova will manage this update and request current data, as needed, so that you remain in network with no interruption in patient care.

Government Contracting & Updates

We partner with you to update and implement several types of government contracts. Those can be any or all, of the following:

• Straight Veteran's Affairs Agreement

• Tricare for Life

• Humana Military or Healthnet Federal Services, depending on service state

• Veteran's Affairs Community Care Network (VA CCN)

Nova Healthcare has a dedicated professional for Government Contracting. There are several systems the government uses, such as Sam.gov, iupdate, and the Federal Service Desk, which will all have to be current with your faciliti’s information. Nova has the government clearance, which is needed in order to achieve this. 

While this can be a complex and foreign process, we have established successful relationships within the system to facilitate favorable outcomes with your contract.