Providers set rates and terms. Purchasers agree to them directly. No insurance carrier sits in between deciding the price for either side.
Direct healthcare contracting lets an employer and a provider agree on rates and terms directly, without an insurance carrier setting the price in between. On OpenNetworks, providers publish rate sheets and terms, purchasers select them into a network, and the agreed terms govern every claim automatically — with no renegotiation required per claim.
Providers set rates and terms once, tied to the specific business conditions they require.
Providers can offer different rate sheets to different purchasers based on relationship and volume.
Payment rules, pre-authorization thresholds, and audit rights are defined once and applied to every claim.
Contracts sit directly between purchaser and provider — OpenNetworks facilitates, it doesn't broker.
Employers and TPAs get rates negotiated for their specific population, without a carrier taking a cut of the arrangement.
Providers keep control of the terms they offer — no exclusivity requirements, no gag clauses, no third party renegotiating on their behalf.