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Platform · 04 · Contracts

Every payer contract.
Open to every team.

One searchable library of your payer agreements. Admissions, case managers, MDS coordinators and finance read the same terms, and MedFlo applies them across the patient journey.

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Contract librarySearch by plan, level of care or carve-out
Search every contract
ContractPlanNetworkAuthorizationReviews
2026 Medicare Advantage agreementMA HMOIn networkBefore admissionEvery 7 days
Commercial PPO agreementCommercialIn networkBefore admissionEvery 5 days
Managed Medicaid agreementMedicaid planIn networkWithin 2 daysEvery 14 days
Medicare Advantage PPO agreementMA PPORenewal pendingBefore admissionEvery 7 days
Regional HMOCommercialOut of network——
Where it sits in the journey

Alongside every step. One source of terms.

Contracts feed network status, authorization rules, review cadence, coverage checks, MDS and billing. Billing outcomes will flow back into the library.

Fed byBilling outcomes · coming soon
Contracts
FeedsAdmissionsPre-authorizationCase managementPayer change detectionMDSBilling · coming soon
What it does
One libraryEvery payer agreement in one place, searchable by plan, level of care or carve-out.
Every teamAdmissions, case managers, MDS coordinators and finance read the same terms.
The terms that matterNetwork status, authorization rules, review cadence, carve-outs and rates.
Applied automaticallyNetwork checks, authorizations, review schedules and coverage checks follow the contract.
Search

Search the way each team asks

Look up a plan, a level of care or a carve-out and get the exact clause, with the page it came from. No more emailing finance to ask what a contract says.

carve-out
Plan: All plansLevel of care: Skilled
2026 Medicare Advantage agreementp. 14
"Negative-pressure wound therapy supplies are carved out of the per diem rate…"
Managed Medicaid agreementp. 7
"High-cost medications above the threshold are carved out and billed separately…"
Commercial PPO agreementp. 19
"Dialysis services are carved out of the daily rate…"
2026 Medicare Advantage agreementKey terms
Network statusIn networkAdmissionsp. 2
AuthorizationRequired before admissionAdmissionsp. 9
Concurrent reviewEvery 7 daysCase managersp. 11
Carve-outsWound VAC outside per diemFinancep. 14
RatesPer diem by PDPM classificationMDS · Financep. 18
Shared terms

One contract, read by every team

Network status matters to admissions, review cadence to case managers, rates to MDS coordinators and finance. Each term is pulled out of the agreement once, with its page, and everyone works from the same answer.

Applied

Terms applied across the journey

The library is not a filing cabinet. MedFlo uses each contract to set network status on referrals, decide when authorization is required, schedule reviews, check new plans after a coverage change and, when billing arrives, price claims.

Where terms are appliedAcross the journey
01AdmissionsNetwork status on every referralApplied
02Pre-authorizationWhen authorization is requiredApplied
03Case managementReview cadenceApplied
06MDSRates alongside PDPMApplied
07Payer change detectionTerms for the new planApplied
08BillingRates and carve-outsComing soon
Connected in the journey
AdmissionsNetwork status on every referral.Pre-authorizationAuthorization rules per payer.Case managementReview cadence from the contract.MDSRates alongside clinical reimbursement.Payer change detectionTerms for the new plan.BillingComing soon.

Start with admissions.
Grow into the whole journey.