Standard Modular Contract
The case for a new kind of contract
Managed care contracts are inefficient, complex, and opaque, making it nearly impossible for patients to predict healthcare costs. Providers waste time and money navigating clinical policies and utilization requirements, appealing denials and underpayments ($19.7B annually, with a 54% success rate), and chasing patient collections (48% success rate, over $500M in losses).
- Providers reduce inefficiencies, diversify revenue, and scale operations.
- Group purchasers build bespoke networks tailored to employee needs and company financial goals.
- Patients can finally predict healthcare costs.
In the sections below, you'll find zero-cost templates to help you implement better agreements, set simplified and transparent billing and payment terms, and streamline authorizations. For additional strategic or operational support, explore the Turquoise Health offering (coming soon!).
Agreement
This template contract language is simple, straightforward, and transparent. The terms are designed to optimize operational efficiency and enhance the patient experience, requiring minimal to no redlining from either party. The table below outlines key terms, compares them to the status quo, and highlights their impact.
Section | Status Quo | Template | Impact |
|---|---|---|---|
| Prior Authorization | Hunt and peck for payment policies related to procedures. 72-hour minimum turnaround on Prior Authorizations. | Universal Clinical Coverage determinations. | No pre-pay denials. No delays in care. |
| Payment Time | Payments from payors take an average of 25 days. | 72 hours. | Enhanced provider cash flow. |
| Payment Terms | Variable and fixed payment terms. Administrative complexity. | Fixed payment methods. | Retraining revenue cycle staff. Administrative simplicity. Time savings. |
| Patient Collections | Complex benefits make patient collections difficult. Language mirrors that complexity. | Fixed fees and benefits, allowing patients to know out of pocket up front. Collections before services are rendered are accurate. | No patient A/R. |
| All Terms | Proprietary and Confidential. | Transparent to all parties: Patient, Payor, Employer, Provider, Regulators. | Easy regulatory filings, Self-Service Q&A, predictability, and accountability. |
Billing & payment
Standard Service Packages (SSPs)
Today's episode groupers are proprietary and rely on outdated logic, contributing to widespread industry fragmentation as providers and payers implement bespoke processes to support them.
Standard Service Packages (SSPs) consolidate all medical services, materials, and fees associated with a healthcare procedure into a single code. They are open-source (and always will be), patient-first, and clearly distinguish between services, encounters, and episodes. SSPs are fully compatible with existing transaction rails and payment systems.
Authorization
Universal Clinical Coverage
Providers spend approximately $19.7 billion annually on denial reviews and $10 billion on obtaining prior authorizations.
Universal Clinical Coverage minimizes the burden on providers by streamlining prior authorizations and reducing claim denials through open-license, rules-based, real-time coverage determinations. Accessible via API, it serves as a provider- and patient-friendly reference library and rule set, aggregating and simplifying widely accepted clinical coverage criteria specific to each SSP.
Turquoise does not assume responsibility for the contents of, or the consequence of using, any version of the provider agreement or any other document found on our website. Before using any of these forms, you should consult with a knowledgeable lawyer.