Payer contract management that reads every date from its clause and checks every payment against it
Every payer contract turned into cited terms, every deadline tracked
See one case, screen by screen ↓Software that keeps a manufacturer's payer agreements — PBM, health plan, Medicare Part D, GPO, health system, specialty and Medicaid — as structured terms, tracks every dated duty they create and checks payments against them. Payer Contract Management adds eight agents that abstract every agreement and amendment into cited terms, put every date on one obligation calendar and check each rebate and fee payment against the clause in force.
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A US brand manufacturer holds dozens of payer agreements — national PBMs, commercial health plans, Medicare Part D sponsors, GPOs, health systems, specialty pharmacies, employer coalitions and Medicaid pools — and amends them every year. Each one carries dated duties: the last day to give notice not to renew, renewals, price-protection checks, audit windows, data files, rebate payments and fee reviews. Those dates live in signed PDFs and get re-typed into spreadsheets and personal calendars.
So an evergreen notice window passes and a contract renews for a year on terms nobody chose. Payers invoice from their own fee schedules, and the rebate engine pays what is billed unless someone re-reads the clause. And an amendment can quietly set a new Best Price — health plan rebates count — and raise Medicaid unit rebates for a quarter before government pricing has seen it.
Estimated split for one payer amendment, by hand and with the solution, in working days.
Seven agents read, reconcile and check every contract and payment, and an eighth publishes the approved terms; people decide every term, notice and variance.
Northwind Bio sells Veltrimab, Corventa and Talmirex under 20 payer agreements worth $4.24B gross a year. On Wednesday 7 October the contract team opens its calendar. Here is what happens next, screen by screen, in the working solution.
Dana's home screen is the month: 42 obligations from 20 contracts, 31 still open, each a chip on its day coloured by type — notice deadline, term and renewal, price protection, audit window, data due, payment due, fee review. One chip is solid red. On the right, four signed copies are waiting, led by Northgate Health Plan's Amendment 2, not read yet.
“Every dated duty in 20 payer contracts, read from its clause.”
At 07:04 the payment checker recomputed 6 October payments from the clause in force; 3 differ, $1.81M paid above the clauses. The largest: Crestline Rx billed its Q2 administrative fee at 4.5% of WAC, the rate in its standard fee schedule, where §6.1 sets 4.0% — $13.95M paid against $12.40M owed on $310.0M of eligible WAC sales. It is inside the 90-day dispute window, so Lena opens a recovery claim for $1.55M, deducted from the next invoice. Alder Benefit Partners (+$173K, 1,180 340B units that §3.4 excludes) and Marlowe Specialty Pharmacy (+$85K, a 2.50% fee from a proposal never signed) wait for her decision.
The payment checker never changes or holds a payment. Revenue accounting decides.
The red chip is Summitview Rx, a $220M-a-year PBM agreement. Its term ends Jan 10, 2027 and renews yearly; §12.2 needs 90 days' written notice, so the last day is Monday, Oct 12. Its 4.5% administrative fee is outside the playbook. Sam drafts the notice not to renew from §12.1 and §12.2, signs and sends it by courier and email, as the notices section requires, with Legal copied — or he could let it renew with a recorded reason.
“If nothing is sent, the agreement renews on its current terms for another year, to Jan 10, 2028.”
Northgate Health Plan signed Amendment No. 2 on Oct 6; it arrives through the e-signature envelope and our countersignature waits on this review. Contract intake links it to agreement NWB-NG-2025-01 and matches 3 products to the product master. The term abstractor reads 24 terms from 3 pages, the amendment reconciler finds 10 changed values, the playbook checker finds 4 variances against 8 rules, and the obligation tracker proposes 6 dated duties.
Price impact checker: “Corventa lowest net $379.44 is below Best Price $409.42.”
Every term sits beside the passage it came from, highlighted in the signed copy. Corventa moves from Preferred (parity) at 30.0% to Exclusive at 38.0% of WAC, with new exclusivity conditions and a 30.0% fallback if they are not met. The administrative fee rises from 3.0% to 5.5% of WAC per eligible unit, and the exhibit describing the services it pays for is deleted. Dana confirms the terms; price terms always need a person.
The term abstractor never confirms a price term on its own.
The reconciler applies Amendment 2 to the base agreement and Amendment 1 and shows each old value beside the new one. The term now ends Dec 31, 2027. The price-protection threshold drops from 7.0% on net WAC to 5.0% on actual WAC, the plan's audit look-back grows from 24 to 36 months, and notice not to renew falls from 90 days to 60. Everything else stays as signed.
Superseded values are kept with their dates, never overwritten.
At 38.0% of a $612 WAC the lowest net price is $379.44, below the current Best Price of $409.42 set by Lakeview Health System in Q2 2026. Health plan rebates count toward Best Price, so in the first quarter the new price applies the Medicaid unit rebate rises from $151.78 to $181.76 on about 118,400 units — about $3.55M more a quarter. If the 5.5% fee is not bona fide, the lowest net would be $345.78.
“Needs government pricing before countersignature.”
Dana confirms the 24 terms and routes the amendment to pricing review. Omar approves countersignature and the pricing effect, with a note for the record: the exclusive access is worth the Medicaid effect per the deal model, and the administrative fee must carry a fair-market-value study before Jan 1 or be capped at 4.0%. His name, the time and the note go to the audit trail.
“I approve countersignature of Northgate Health Plan Amendment No. 2 and the pricing effect shown.”
Dana publishes. The term publisher maps the confirmed terms to the rebate engine and proves the test calculation matches, records the $379.44 Best Price candidate from Jan 1, 2027 in the pricing calculation with the fee flagged for study, and updates the ERP accrual rates. Northgate's six duties go live with owners and reminders — first, the new last day to end the agreement on 60 days' notice, Nov 2, for Sam Patel.
The term publisher publishes only approved terms, and every publish is on the audit trail.
The same contracts, seen by the five people who carry them — what their quarter looked like, and what it looks like now.
Seven agents read, reconcile and check every contract and payment, and an eighth publishes the approved terms; people decide every term, notice and variance.
Takes signed contracts from the e-signature envelope and the contracts mailbox, decides agreement, amendment or side letter, and links each to its parent agreement, payer and products.
Reads every clause — tables, defined terms and cross-references — and fills each term with a value, a confidence and the clause it came from: tiers and rates, exclusivity and fallback, fees, price protection, 340B and other exclusions, audit, notice, data, payment and dispute clocks.
Applies each amendment to the base agreement and earlier amendments, so the terms in force on any date are known, and flags any section an amendment cites that does not exist.
Compares every term with the clause playbook — standard, fallback, walk-away — lists each variance with its clause and the rule it breaks, and compares rates and dates with the approved deal sheet.
Works out the lowest net unit price each term allows and compares it with the current Best Price, tests whether each fee can stay a bona fide service fee, shows the Medicaid unit rebate effect and estimates price-protection exposure.
Turns notice, renewal, price-protection, audit, data, payment and fee clauses into dated duties with owners and reminders, and scans them every morning.
Recomputes every rebate payment, fee invoice and chargeback credit from the clause in force for the period it covers — rate, eligible units, exclusions such as 340B, fee caps — and flags any difference above $1,000 on the calendar.
Sends confirmed, approved terms to the rebate engine, the pricing calculation, the ERP accrual model and the contract system, then proves the test calculation matches the cited rate.
Confirms every term. The agents propose; a named person decides.
Ask in plain words. Answers come from the 20 agreements, their amendments, the clause playbook and the pricing record, and open the exact clause behind them.
What did we pay that the clauses do not support?
Three October payments differ from their clauses — $1.81M paid above what the contracts allow. Crestline Rx: clause 4.0% of WAC, paid 4.5% (+$1.55M). Alder Benefit Partners: clause excludes 340B units, paid 1,180 of them (+$173K). Marlowe Specialty Pharmacy: clause 2.25% of WAC, paid 2.50% (+$85K). All three are inside the 90-day dispute window, so each can be recovered from the next invoice. Lena Ortiz decides.
Which notice deadlines fall before year end?
Five: Summitview Rx on Oct 12, Cobalt Employers Coalition and Lakeview Health System on Nov 1, Havenridge Health System and Alder Benefit Partners on Dec 31. Northgate's new 60-day notice will add Nov 2 once Amendment 2 is abstracted. Sam Patel gets reminders 30, 14 and 7 days before each one.
Could any contract set a new Best Price?
One does, and one is close. Northgate Amendment 2: Corventa exclusive at 38.0% gives a lowest net of $379.44, below today's Best Price of $409.42 — about $3.55M more Medicaid rebate a quarter, or $345.78 if the 5.5% fee is not bona fide. Granite Amendment 4: 31.5% leaves the net only 2.4% above, and Omar Haddad has it in pricing review. PBM rebates other than mail order, and Part D rebates, do not count toward Best Price.
What changed in Northgate Amendment 2?
Ten values change from Jan 1, 2027: Corventa from Preferred at 30.0% to Exclusive at 38.0% with a 30.0% fallback, the administrative fee from 3.0% to 5.5%, price protection from 7.0% on net WAC to 5.0% on actual WAC, the audit look-back from 24 to 36 months and notice from 90 to 60 days — plus a new exclusivity condition, a new baseline WAC date, the fair-market-value exhibit deleted and the term extended to Dec 31, 2027. The Corventa rate needs government pricing: it would set a new Best Price.
13 screens from the working solution, on its sample data. Pick one to see it large.
Who decides what, what the agents may confirm and when people are reminded are settings — changed and saved on the record.
| Setting | Default | Choose from |
|---|---|---|
| Lowest net price below Best Price | Omar Haddad | Government pricing decides before countersignature · Omar Haddad · Lena Ortiz |
| Fee above the playbook cap or without a fair-market-value study | Omar Haddad | Also routed to government pricing · Omar Haddad · Priya Raman |
| Clause outside the playbook | Priya Raman | Legal approves the variance · Priya Raman · Sam Patel |
| Publish terms to downstream systems | Dana Okafor | Contract operations, after every term is confirmed · Dana Okafor · Lena Ortiz |
| Never confirm price terms automatically | On | Rates, fees and price protection always need a person · On · Off |
| Confirm dates and parties at 97% confidence or more | Off | Everything else is shown for confirmation · On · Off |
| Compare every signed copy with the approved deal sheet | On | Flags any rate or date that differs · On · Off |
| Notice and renewal reminders | 30, 14 and 7 days before | 30, 14 and 7 days before · 60, 30 and 7 days before |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample contracts · “target” = the design goal, measured in the live solution · “estimated” = our estimate · “typical” = published figures (MMIT rebate-leakage research — 2–3% of revenue for a mid-sized manufacturer; Sirion and UpCounsel on evergreen notice windows, 30–90 days; Drug Channels, as cited by Thirdsight and Pharmaceutical Commerce, on 2024 gross-to-net reductions; Medicaid Best Price and bona fide service fees, 42 CFR 447.502 and 447.505). People, companies, products and contracts named on this page are fictional — characters and sample data in the working solution.
Software that keeps a manufacturer's payer agreements — PBM, health plan, Medicare Part D, GPO, health system, specialty and Medicaid — as structured terms, tracks every dated duty they create and checks payments against them. Payer Contract Management adds eight agents that abstract every agreement and amendment into cited terms, put every date on one obligation calendar and check each rebate and fee payment against the clause in force.
The obligation tracker computes each date from its confirmed clause — for example, the last day to give notice is the renewal date less the notice days — and assigns an owner. The deal desk is reminded 30, 14 and 7 days before each notice deadline, and the notice letter can be drafted from the clause.
The payment checker recomputes every rebate payment, fee invoice and chargeback credit from the clause in force for the period it covers, including eligible units, 340B exclusions and fee caps. Any difference above $1,000 is flagged on the calendar with the clause, the arithmetic and the dispute window, for revenue accounting to decide.
Yes. The price impact checker works out the lowest net price each term allows, compares it with the current Best Price from the pricing record, tests whether each fee can stay a bona fide service fee and shows the Medicaid unit rebate effect. Any flag goes to government pricing before countersignature.
The amendment reconciler applies each amendment to the base agreement and earlier amendments, so the terms in force on any date are known. Every changed value is shown beside the old one, and superseded values are kept with their dates.
No. Price terms always need a person, dates come only from confirmed clauses, the payment checker never changes or holds a payment, and only approved terms reach the rebate engine, pricing calculation and ERP.
Yes. Contract operations confirms the terms and publishes them, the deal desk decides every notice and renewal, revenue accounting decides every payment variance, government pricing signs every Best Price flag and Legal approves every playbook variance. Each decision is on the audit trail.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your agreements and amendments, clause playbook, product master and a sample of recent payments — and it goes live once every quality gate has passed. We will walk you through it on your own contracts first.
Every GVD sentence linked to its source and checked against the label.
1-min demoRebate Claims ValidationEvery rebate invoice line checked, every dispute backed by its clause.
1-min demoPayer Coverage Policy TrackingEvery payer policy change caught within a day of posting, checked against the contract.
1-min demoWe'll run Payer Contract Management on a sample of your own agreements, amendments and recent payments.