03423    a2200325   4500003000600000005001700006008004100023020002900064040002000093041000800113050002300121110004500144245010900189250001900298264006500317300003200382336002600414337002800440338002700468500003400495504004100529505103100570520128201601650003202883650003602915650003902951700003402990700003903024700003403063PUCPR20250306143405.0121224s2021    dcua   frf    001 0 eng d  a9781663313881qpaperback  aPUCPRbengerda  heng  aKF 1183b.H43 2021  aAmerican Health Law Associationeauthor.1 aHealth plans contracting handbook :ba guide for payers and providers /cAmerican Health Law Association  aEighth edition  aWashington, D.C. :bAmerican Health Law Association,c©2021  axxxiii, 524 pages ;c27 cm.  atextbtxt2rdacontent  aunmediatedbn2rdamedia  avolumebnc2rdacarrier  aIncludes index: p. 499 - 524.  aIncludes bibliographical references.  a1. Introduction: basics of contracting and negotiating -- 2. Accountability and collaboration in payer-provider relationships -- 3. Antitrust issues in payer-provider contracting -- 4. Key contract definitions -- 5. Policy and procedure amendments -- 6. Payer programs and policies: utilization management and quality assurance -- 7. Payment methodologies -- 8. Term and termination provisions -- 9. Insurance requirements and indemnification -- 10. Other material contract provisions -- 11. Provisions related to data sharing -- 12. Dispute resolution -- 13. Protecting against insolvency -- 14. Medicare managed care contracting -- 15. Medicaid managed care -- 16. Direct-to-employer contracting -- 17. Considerations in the absence of a contract between provider and payer -- Appendix A. Glossary of health plan contracting terms -- Appendix B. Table of sample clauses -- Appendix C. Physician group practice provider agreement template with commentary.gIncludes glossary: p. 439 - 451.gIncludes appendixes: p. 439 - 524.  a"The Health Plans Contracting Handbook: A Guide for Payers and Providers, published by the American Health Law Association, is the 8th edition of a work that has served as a resource for practitioners for two decades. It has become a classic and one of the essential tools of the health law practitioner's library. The intent behind the Health Plans Contracting Handbook is to provide advice on addressing the issues that arise in managed care network relationships. These contracts often endure for years at a time and must document increasingly dynamic relationships between the parties, including changes in products, governing laws, and medical and ad1ministrative best practices for both payers and providers alike. As with prior editions, this book attempts a balanced approach and practical focus, rather than exhaustive reporting on the state of the law. We aim to provide sample clauses to assist you in thinking about and drafting appropriate language; many of which are based on real examples. Throughout the book, the authors have provided cites to cases or state statutes to help you begin research as needed, but an exhaustive description of the state of the law, including the variations among jurisdictions, is beyond the scope of this publication." -- Preface. 0aMedical carezUnited States 0aHealth insurancezUnited States 0aInsurance contractszUnited States  aFisk, Robineeditor in chief.  aDegraff-Murphy, Christinaeeditor.  aMitchell, Gregory R.eeditor.