Healthcare · Moraph software

Payer Contract Lifecycle Management

Know what each payer agreed to pay, and find where they paid less

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Overview

What you are buying

Payer Contract Lifecycle Management keeps your payer contracts, amendments and fee schedules in one place, with the terms modeled so they can be calculated. It compares what each payer actually paid on every remittance with what the contract says it should have paid, and turns the variances into worklists for appeals and payer follow-up. It also tracks renewal and notice dates, so negotiations start from evidence rather than from the calendar.

The problem it solves

Payer contracts are negotiated once, filed as PDFs, and then rarely consulted. Fee schedules change by amendment, carve-outs and escalators are buried in exhibits, and the expected reimbursement loaded in the billing system drifts from what was signed. Underpayments are spotted only when someone happens to notice, appeal deadlines pass, and renewal notices arrive with no clear picture of how the payer has performed under the current terms.

  • Contracts, amendments and fee schedules sit in different places and versions
  • Expected reimbursement in the billing system does not match the signed terms
  • Underpayments are found by chance and appeal windows are missed
  • Renegotiations start without evidence of how each payer actually paid

Who uses it

  • Managed care and payer contracting teams at hospitals, health systems and physician groups
  • Revenue cycle leaders who answer for net revenue
  • Underpayment and denial analysts who work variances and appeals
  • Finance teams who model contract changes and reserves
  • Compliance staff who oversee overpayment identification and refunds

Requirements it supports

HIPAA Administrative Simplification, transactions and code sets (45 CFR Part 162)HIPAA Privacy and Security Rules (45 CFR Parts 160 and 164)Medicare reporting and returning of overpayments (42 CFR 401.305)False Claims Act (31 U.S.C. 3729 to 3733)Hospital Price Transparency rule (45 CFR Part 180)No Surprises Act (Consolidated Appropriations Act, 2021, Division BB)

The product supports these requirements; meeting them remains your organization’s responsibility.

See how it works

A short walkthrough

Illustrative screens with fictional sample data. They show the workflow, not any client’s data or configuration, and the layout of the product itself differs. A live demonstration uses the product with sample data.

  1. Step 1

    A contract and its terms

    Each contract keeps its documents, versions and key dates together with the payment terms modeled from it.

    Example Health Plan (fictional) · Commercial PPO

    Current version
    Amendment 3, effective Sample date
    Inpatient
    Per diem by level of care, stop-loss above threshold
    Outpatient
    Fee schedule, lesser of billed charges
    Escalator
    Annual, per contract exhibit
    Notice date
    Approaching
    Model status
    Approved by second reviewer

    Documents

    • Base agreement (fictional sample)
    • Amendments 1 to 3
    • Outpatient fee schedule exhibit
    Each contract keeps its documents, versions and key dates together with the payment terms modeled from it.

  2. Step 2

    The variance worklist

    Analysts work variances sorted by amount and deadline, each with its likely cause.

    ClaimPayerExpectedPaidVarianceCauseAppeal due
    CL-884213Example Health Plan$14,280.00$11,904.00-$2,376.00Old fee schedule appliedSoon
    CL-884190Example Health Plan$612.40$489.92-$122.48Old fee schedule appliedLater
    CL-883977Sample Mutual (fictional)$38,400.00$31,200.00-$7,200.00Stop-loss not appliedLater
    CL-883811Sample Mutual (fictional)$1,045.00$0.00-$1,045.00Denied, referredLater
    CL-883702Example Health Plan$2,210.00$2,410.00+$200.00Possible overpaymentCompliance
    Analysts work variances sorted by amount and deadline, each with its likely cause.

  3. Step 3

    Why the payment is short

    Each variance shows the repricing calculation and the contract term it relies on, so the analyst can confirm it.

    Claim CL-884213 · Example Health Plan (fictional)

    Date of service
    Sample date
    Contract version
    Amendment 3
    Expected
    $14,280.00
    Paid
    $11,904.00
    Remark codes
    Payment adjusted per fee schedule

    Calculation

    • Line 1: rate from Amendment 3 fee schedule applied
    • Line 2: rate matches the schedule from Amendment 2, which had ended
    • Lesser-of check: billed charges higher, contract rate applies
    Each variance shows the repricing calculation and the contract term it relies on, so the analyst can confirm it.

  4. Step 4

    A systemic issue

    When the same cause affects many claims, they are grouped and raised with the payer once.

    Example Health Plan (fictional) · Prior fee schedule still applied

    1. Variance group detected across 146 claimsSystem
    2. Cause confirmed on a sample of claimsUnderpayment analyst
    3. Issue raised with payer representative with claim listContract manager
    4. Payer acknowledges loading errorContract manager
    5. Reprocessed payments matched to claimsSystem
    When the same cause affects many claims, they are grouped and raised with the payer once.

  5. Step 5

    Payer scorecard

    Before a renewal, the contracting team sees how each payer has paid under the current terms.

    PayerClaims auditedWith varianceUnderpaid (confirmed)RecoveredOpen
    Example Health Plan (fictional)18,4201,102$412,300$298,100$114,200
    Sample Mutual (fictional)9,871644$286,900$141,500$145,400
    Demo Care Plan (fictional)6,215201$58,200$52,700$5,500
    Before a renewal, the contracting team sees how each payer has paid under the current terms.

  6. Step 6

    Modeling a renewal

    Proposed rates are applied to past volumes so negotiators see the effect by service line before they agree.

    Service lineVolume (sample year)Current termsPayer proposalOur counter
    Inpatient medical2,140 days$6,420,000$6,548,400$6,741,000
    Outpatient imaging11,830 claims$3,105,000$3,043,000$3,260,000
    Outpatient surgery1,912 cases$5,736,000$5,621,000$5,965,000
    Emergency8,604 visits$4,302,000$4,388,000$4,474,000
    Proposed rates are applied to past volumes so negotiators see the effect by service line before they agree.

Workflows

The principal workflows

  1. Capture the contract

    Each contract, amendment and fee schedule is stored with its effective dates, and its payment terms are modeled so they can be calculated: rates, methodologies, carve-outs, stop-loss and escalators.

    • Contract documents and amendments uploaded with effective dates
    • Payment terms modeled by service line and methodology
    • Fee schedules loaded and linked to the contract version
    • Key dates recorded: term, renewal, notice and timely filing windows
    • Model reviewed and approved by the contract owner

  2. Audit payments

    Remittances and claims are loaded from your billing systems, and each paid claim is repriced against the contract terms in effect on the date of service. Differences beyond your tolerance become variances.

    • Claims (837) and remittances (835) loaded on your schedule
    • Each claim repriced against the contract version in effect
    • Expected and actual payment compared line by line
    • Variances created where the difference exceeds your tolerance
    • Overpayments flagged separately for compliance review

  3. Recover

    Underpayments are queued for analysts with the calculation behind the expected amount, grouped by payer and cause so systemic issues are raised once rather than claim by claim.

    • Variances grouped by payer, cause and contract term
    • Analyst reviews the calculation and confirms or dismisses the variance
    • Appeal or payer inquiry prepared with the contract reference
    • Appeal deadlines tracked from the remittance date
    • Recoveries and payer responses recorded against the variance

  4. Renew and negotiate

    Ahead of each notice date, contracting teams see how the payer has paid under the current terms and can model proposed rates against your own claims history.

    • Upcoming notice and renewal dates surfaced to the contract owner
    • Payer performance summarized: variances, recoveries and denials
    • Proposed rate changes modeled against historical volumes
    • Negotiation notes and versions kept with the contract
    • New terms approved and loaded with their effective date

Roles and permissions

Who does what in the product

Each role below is a starting point. During implementation we set them up to match your teams, and every action anyone takes is recorded in the audit trail.

Contract manager

Managed care contracting manager, payer relations manager, director of managed care

Keeps each payer contract accurate in the system, from the signed document to the calculable terms, and leads renegotiation.

Sees

  • Contracts, amendments, fee schedules and their versions
  • Key dates and upcoming notice deadlines
  • Payer scorecards and systemic variance groups
  • Rate models prepared for negotiations

Does

  • Uploads contracts and amendments and records effective dates
  • Models payment terms and loads fee schedules
  • Raises systemic issues with payer representatives
  • Prepares and compares rate scenarios for renewals
  • Records negotiation notes and agreed terms
  • Sends new contract models for approval

Cannot

  • Approve a contract model they built themselves
  • Dismiss or write off variances
  • Edit the record of term changes
Approvals
Contract models and changes to terms are approved by a revenue cycle leader or a second contract manager before repricing uses them.
Notified about
Notice and renewal dates approaching, new systemic variance groups for their payers, and model approvals or returns.

Underpayment analyst

Underpayment analyst, reimbursement analyst, payment variance specialist, collector

Turns variances into recoveries: confirms the underpayment, follows up with the payer and records the outcome.

Sees

  • Variances assigned to them or their team, with the repricing calculation
  • The claim, remittance and contract terms behind each variance
  • Appeal deadlines and payer responses
  • Their own open work by age and amount

Does

  • Reviews the expected calculation and confirms or dismisses each variance with a reason
  • Prepares appeals and payer inquiries from templates
  • Records payer responses and recoveries
  • Groups related variances and refers systemic issues to the contract manager
  • Reports suspected contract model errors

Cannot

  • Change contract terms or fee schedules
  • Write off a variance above the limit your policy sets
  • Decide on overpayment refunds
Approvals
Write-offs above the policy limit and dismissals of systemic groups are approved by a revenue cycle leader.
Notified about
New variances assigned to them, appeal deadlines approaching, payer responses received, and write-offs approved or returned.

Revenue cycle leader

Revenue cycle director, VP of revenue cycle, patient financial services director

Sets priorities for recovery work, approves the contract models repricing relies on, and reports results.

Sees

  • All contracts, variances, appeals and recoveries
  • Program reporting: open variances, recoveries and missed deadlines
  • Payer scorecards across all payers
  • The full audit trail

Does

  • Approves contract models and term changes
  • Approves write-offs above the analyst limit
  • Sets variance tolerances and assignment rules
  • Decides which systemic issues are escalated to payers
  • Prepares leadership reporting

Cannot

  • Approve a contract model they built themselves
  • Edit or delete entries in the audit trail
  • Close an overpayment flag; that belongs to compliance
Approvals
Approves contract models, tolerances and write-offs; their own models need a second approver.
Notified about
Models awaiting approval, write-offs over the limit, large systemic variance groups, and appeal deadlines at risk.

Finance analyst

Decision support analyst, financial planning analyst, reimbursement finance analyst

Uses contract models and claims history to estimate expected revenue and the effect of proposed rate changes.

Sees

  • Contract models and fee schedules
  • Expected and actual payment totals by payer and service line
  • Rate scenarios prepared for negotiation

Does

  • Builds and compares rate scenarios against historical volumes
  • Reviews expected revenue for budgeting and reserves
  • Exports model results for finance reporting

Cannot

  • Change contract terms in force
  • Work, dismiss or write off variances
  • See appeal correspondence unless granted
Approvals
Scenarios they prepare are shared with the contract manager; none take effect without an approved contract change.
Notified about
Contract terms changed, and scenarios shared with them.

Compliance reviewer

Compliance officer, compliance analyst, credit balance specialist

Reviews payments above the contracted amount so overpayments are investigated and returned under your policy.

Sees

  • Payments flagged as possible overpayments, with the calculation
  • The claim, remittance and contract terms behind each flag
  • The history of decisions and refunds

Does

  • Reviews each flag and records whether it is an overpayment
  • Records refunds and the date the overpayment was identified
  • Refers patterns to the contract manager or billing team
  • Prepares overpayment reporting for the compliance committee

Cannot

  • Change contract terms
  • Work or write off underpayment variances
  • Delete an overpayment flag
Approvals
Refund decisions follow your compliance policy; the app records who decided and when.
Notified about
New overpayment flags and flags open beyond the period your policy sets.

Auditor (read-only)

Internal auditor, external auditor (under temporary access)

Reviews contract models, calculations and decisions without being able to change anything.

Sees

  • Contracts, models and fee schedules within the scope granted
  • Variances, appeals, write-offs and overpayment decisions
  • The audit trail

Does

  • Searches and reads records within their scope
  • Exports records and reports they have been given, with each export logged

Cannot

  • Change, approve or delete anything
  • See records outside the scope and dates granted
  • Keep access after it expires
Approvals
Their access is approved by the revenue cycle leader or an administrator, with a scope and an end date.
Notified about
Nothing by default.

Administrator

Application administrator, revenue cycle systems analyst

Manages users, data feeds and configuration, without deciding contract terms or variances.

Sees

  • Users, roles, facilities and payer lists
  • Claim and remittance feed status and data quality results
  • The record of permission changes

Does

  • Adds and removes users, or maps them from single sign-on groups
  • Assigns roles and facility or payer scopes
  • Monitors data feeds and resolves load errors
  • Runs access review reports

Cannot

  • Change contract models or fee schedules
  • Work, dismiss or write off variances
  • Grant themselves a revenue cycle role without a second administrator
Approvals
Role changes that grant approval rights are confirmed by the revenue cycle leader.
Notified about
Feed failures, data quality issues, access reviews coming due and unused accounts.

Permissions at a glance

ActionContract mgrAnalystRC leaderFinanceComplianceAuditorAdmin
View contracts and fee schedulesFullView onlyFullView onlyView onlyView onlyNo access
Upload and model contract termsFullNo accessFullNo accessNo accessNo accessNo access
Approve contract modelsApprovesNo accessApprovesNo accessNo accessNo accessNo access
Work and confirm variancesView onlyOwn work onlyFullNo accessNo accessView onlyNo access
Prepare appeals and inquiriesFullOwn work onlyFullNo accessNo accessNo accessNo access
Write off a variance above limitNo accessNo accessApprovesNo accessNo accessNo accessNo access
Review overpayment flagsView onlyNo accessView onlyNo accessFullView onlyNo access
Build rate scenariosFullNo accessFullFullNo accessNo accessNo access
Set tolerances and assignment rulesNo accessNo accessFullNo accessNo accessNo accessNo access
Manage claim and remittance feedsNo accessNo accessView onlyNo accessNo accessNo accessFull
View audit trailView onlyNo accessView onlyNo accessView onlyView onlyView only
Manage users and rolesNo accessNo accessApprovesNo accessNo accessNo accessFull
  • Full
  • Own work only
  • Approves
  • View only
  • No access

How access is controlled

  • Contract models are checked by a second person before repricing uses them, because every variance depends on them. Nobody approves a model they built themselves.
  • Overpayments are kept separate from underpayment work: compliance reviewers decide on them, and analysts cannot write off or close an overpayment flag.
  • Roles are configured with you during implementation. You can rename them, add custom roles, and limit them by facility, payer or service line, and every permission change is recorded.
  • Staff sign in through your identity provider, and roles can follow its groups. Auditors get temporary read-only access with a defined scope and an end date.

Features

What it does

Contract repository

Contracts, amendments, exhibits and correspondence stored together, with versions and effective dates so the terms in force on any date are clear.

Payment term modeling

Fee schedules, percent of charges, per diems, case rates, DRG and APC-based methods, carve-outs, stop-loss and lesser-of provisions modeled so they can be calculated.

Claim repricing

Each paid claim repriced against the contract version in effect on the date of service, with the calculation shown step by step.

Variance detection

Expected and actual payments compared line by line, with tolerances you set, and variances classified by likely cause.

Underpayment worklists

Variances queued by payer, cause, amount and appeal deadline, with assignment rules and team views.

Systemic issue grouping

Variances with the same cause across many claims grouped, so a payer loading error is raised once with all affected claims.

Appeal support

Appeal letters and payer inquiries prepared from templates with the claim, the expected calculation and the contract reference.

Overpayment identification

Payments above the contracted amount flagged for compliance review, so credit balances and refunds are handled under your policy.

Key date tracking

Term, renewal, notice, rate escalator and timely filing dates tracked with reminders to the contract owner.

Rate modeling

Proposed rate changes modeled against your historical claims volumes, so negotiators can see the effect before agreeing.

Payer scorecards

How each payer has paid under its contract: variances, recoveries, response to appeals and patterns over time.

Complete record

Every term change, approval, variance decision and appeal kept with the person, time and reason.

Integrations

How it connects to your systems

Connects toHowWhat flows
Billing and patient accountingClaims and account detail from your billing system by scheduled file or interface, mapped during implementation.In: claims (837 or extract), charges, codes and account status.
Electronic remittancePayer remittances from your clearinghouse or billing system, including adjustment and remark codes.In: 835 remittances with payments, adjustments and reason codes.
Payer fee schedulesFee schedules and rate files as supplied by payers or published for government programs, loaded and linked to contract versions.In: rate tables by code, modifier and effective date.
Denial managementVariances caused by denials passed to your denial management process, and denial outcomes received back.Out: denial-related variances. In: denial status and outcome.
Document managementSigned contracts can be linked from your contract or document management system rather than copied.In: document links and metadata.
Single sign-onStaff sign in through your identity provider (SAML or OpenID Connect).In: user identity and group membership for role assignment.
Work APIExpected payments, variances and recoveries available to your data warehouse and finance tools through the Moraph Work API.Out: repricing results, variances, appeals and recoveries.

Each integration is confirmed in discovery and specified in the design. See how an engagement progresses.

Security and privacy

How your data is protected

Single sign-on

Staff sign in through your identity provider, so your password and multi-factor policies apply.

Role-based access

What each person can see and do follows their role, facility and payer scope; building a contract model is separate from approving it.

Protected health information

Claims and remittances contain patient information, so Moraph signs a business associate agreement and handles that information under it.

Encryption and keys

Client data is encrypted, with keys Moraph staff cannot use without explicit, time-bound authorization.

Complete audit trail

Every view, change, decision and export is logged with the person and time, and cannot be edited.

Data residency

Data stays in the hosting region you choose: the United States, the United Kingdom or Australia.

Company-wide controls, independent audits (SOC 2 Type II and ISO/IEC 27001) and data residency are described in our Trust Center, where you can request the evidence pack.

Reporting

What you can report on

11 standard reports, grouped by who uses them. Each shows who it is for, how it can be broken down, how it is delivered and what it is used for. The data behind them is also available to your own reporting tools.

Recovery

Open variances

For underpayment analysts and team leads

Every open underpayment variance with payer, amount, cause, assignee and appeal deadline.

Break down by
Payer, Cause, Amount band, Analyst, Deadline window
Delivered as
Live dashboard; CSV export
Used for
Working the variances worth the most before their deadlines pass.

Appeal deadlines

For underpayment analysts and the revenue cycle leader

Appeals and inquiries due, counted from the remittance date under each payer's terms, with status and time remaining.

Break down by
Payer, Status, Analyst, Deadline window
Delivered as
Live dashboard; scheduled email
Used for
Making sure no recoverable underpayment is lost to a missed deadline.

Recoveries

For revenue cycle leader and finance

Amounts confirmed as underpaid, appealed, recovered and written off, by payer and period.

Break down by
Payer, Period, Cause, Facility
Delivered as
Live dashboard; PDF; CSV export
Used for
Reporting the results of recovery work and where it should focus next.

Systemic issues

For contract managers and the revenue cycle leader

Groups of variances with the same cause across many claims, with the claims affected and the status of the escalation to the payer.

Break down by
Payer, Cause, Contract term, Status
Delivered as
Live view; CSV export
Used for
Raising payer loading errors once, with all the evidence.

Contracts

Key dates

For contract managers

Every contract's term, renewal, notice and escalator dates, sorted by what is coming soonest.

Break down by
Payer, Date type, Owner, Date window
Delivered as
Live dashboard; scheduled email
Used for
Starting renegotiation before the notice window closes.

Payer scorecard

For contract managers, revenue cycle leader and executives

For each payer, expected against actual payment, variance rates, recoveries, appeal outcomes and trends under the current contract.

Break down by
Payer, Product line, Service line, Period
Delivered as
Live dashboard; PDF for negotiation packs
Used for
Going into a negotiation with evidence of how the payer has paid.

Rate scenario comparison

For contract managers and finance

Proposed rate changes applied to historical claims volumes, compared with current terms by service line.

Break down by
Scenario, Service line, Payer, Volume period
Delivered as
Live view; PDF and CSV export
Used for
Understanding what a proposed rate change would mean before agreeing to it.

Contract model changes

For revenue cycle leader and auditors

Every change to a contract model or fee schedule, who made and approved it, and the effective date.

Break down by
Payer, Change type, Approver, Period
Delivered as
Live view; PDF and CSV export
Used for
Showing that repricing was based on approved terms.

Compliance and audit

Overpayment flags

For compliance reviewers and the compliance committee

Payments above the contracted amount, the date each was identified, the review decision and any refund recorded.

Break down by
Payer, Status, Program, Identified date
Delivered as
Live dashboard; PDF; CSV export
Used for
Evidencing that overpayments are reviewed and returned under your policy.

Write-offs

For revenue cycle leader, finance and auditors

Variances dismissed or written off, with reasons, amounts and who approved them.

Break down by
Payer, Reason, Approver, Amount band, Period
Delivered as
Live view; CSV export
Used for
Checking that write-offs follow policy and approval limits.

Audit trail extract

For internal and external audit

Who viewed, changed, approved or exported a selected contract, variance or period, and when.

Break down by
Record, User, Action, Date range
Delivered as
On request in the product; CSV and PDF export
Used for
Answering audit requests without rebuilding the history by hand.

Exports, access and evidence

  • Every report can be exported to CSV, and summary and evidence reports to PDF. Reports can be scheduled to arrive by email for the people entitled to see them.
  • Each report can be filtered and the filters saved, so an analyst or contract manager can keep their own views. Reports that need a different shape can be built in your own tools from the Work API.
  • Repricing results, variances, appeals and recoveries are available through the Moraph Work API for your data warehouse or finance reporting.
  • Reports respect each viewer's role and scope: an analyst sees their team's payers, finance sees modeled totals, and patient-level detail is limited to the roles that need it.
  • Reports can be run as of a past date using the contract versions in effect then, and give the same result each time. Running and exporting a report is itself recorded in the audit trail.

Deployment

Where and how it runs

Moraph cloud

Hosted and operated by Moraph in the United States region. United Kingdom and Australia regions are available for organizations outside the US.

Dedicated environment

A single-tenant environment for health systems whose policies require isolation, scoped in the proposal.

With a managed service

Optionally run alongside Moraph support for modeling new contracts and amendments and loading fee schedule updates.

Security controls, independent audits and data residency are set out in our Trust Center. Engagement models and what drives a quotation are on Working with Moraph.

Implementation

What a rollout involves

The general phases are on Working with Moraph. For this product, they involve the following.

Contract inventory

We gather your payer contracts, amendments and fee schedules and agree which payers and products to model first. We need the signed documents and a contact from your contracting team.

Term modeling

Payment terms are modeled for each contract and reviewed with your contract managers, who approve each model before it is used.

Data feeds

Claims and remittance feeds from your billing system and clearinghouse are mapped, loaded and checked for completeness.

Historical repricing

A period of historical claims is repriced and the results reviewed with your team, so tolerances are set and model errors corrected before variances go to analysts.

Workflow and roles

Worklists, assignment rules, write-off limits, appeal templates and roles are configured to match your procedures.

Training and go-live

Analysts, contract managers, compliance reviewers and finance users are trained on their own tasks, and payers are added in an order you choose.

Limitations

What it does not do

Worth knowing before you evaluate it.

  • Expected payments are only as accurate as the contract models. Terms are modeled with your team and approved by you, and ambiguous contract language is flagged for your decision rather than interpreted.
  • It does not submit appeals or claims to payers. Your team sends appeals and inquiries through your usual channels and records the outcome.
  • It is not a billing or claims scrubbing system. It works on claims after they are paid or denied, using data from your billing system.
  • Moraph does not hold or collect funds. Recoveries are paid by payers to you through your normal remittance process.
  • Identifying an overpayment does not return it. Refund decisions and any reporting obligations remain with your compliance team.
  • Some payment methodologies need payer or government grouper and pricer data that you license; these are scoped during implementation.
  • It does not provide legal advice on contract terms or disputes. Contract interpretation remains with your contracting team and counsel.
  • Results depend on complete claims and remittance data; gaps in feeds produce gaps in auditing, which data quality checks report.

Evaluation checklist

What to test in a demonstration or pilot

Questions worth putting to us, and to any other vendor you are considering.

  1. Give us one payer contract and a sample of its remittances, and compare the variances found with what your team knows
  2. Check that each repricing calculation is clear enough for an analyst to confirm or dismiss without rework
  3. Review how a systemic issue is grouped and the evidence produced for the payer
  4. Walk through an overpayment flag with your compliance team
  5. Model a proposed rate change against your own volumes
  6. Confirm role separation: who can build, approve and change contract models, and who can write off a variance

Questions

Frequently asked questions

Which payment methods can it model?

Common commercial and government-based methods, including fee schedules, percent of charges, per diems, case rates, DRG and APC-based payment, carve-outs, stop-loss and lesser-of provisions. Unusual terms are reviewed during implementation.

Does it find overpayments too?

Yes. Payments above the contracted amount are flagged for your compliance team to review, separately from underpayment work.

Do we need a business associate agreement?

Yes. Claims and remittances contain patient information, so Moraph signs a business associate agreement before any is loaded.

Does Moraph take a share of recoveries?

The product is offered as a subscription. Moraph does not hold or collect funds; payers pay recoveries to you. See Working with Moraph for what drives a quotation.

Who owns the contract data?

Your organization does. How it is returned to you and deleted at the end of the agreement is set out in the contract.

Is there an accessibility conformance report?

Ask for one through the procurement request form at /how-to-buy/request, naming the version you are evaluating.

Next steps

Evaluate Payer Contract Lifecycle Management

Book a demonstration

See the product working with sample data, focused on your workflows.

Request a demonstration

Request a technical briefing

Architecture, integrations, security and hosting, with our engineers and your technical team.

Request a briefing

Factsheet

This page on two sides, to share with colleagues or add to your evaluation file.

Open the factsheet

Buying through a formal procurement? See How to buy for purchasing routes, accessibility conformance reports and company information. Documentation: Payer Contract Lifecycle Management guides on docs.moraph.com (getting started and security guides are public; setup, administration and integration guides are for client accounts). Support: Payer Contract Lifecycle Management support guide.

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