03556 a2200361 4500 PUCPR 20250306143405.0 121224s2021 dcua frf 001 0 eng d 9781663313881 paperback PUCPR eng rda eng cicres KF 1183 .H43 2021 American Health Law Association 302004 author. Health plans contracting handbook : a guide for payers and providers / American Health Law Association Eighth edition Washington, D.C. : American Health Law Association, ©2021 xxxiii, 524 pages ; 27 cm. text txt rdacontent unmediated n rdamedia volume nc rdacarrier Includes index: p. 499 - 524. Includes bibliographical references. 1. 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. Includes glossary: p. 439 - 451. Includes appendixes: p. 439 - 524. "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. Medical care 134381 United States Health insurance 109215 United States Insurance contracts 115146 United States Fisk, Robin 301840 editor in chief. Degraff-Murphy, Christina 302037 editor. Mitchell, Gregory R. 302038 editor. 6 lcc 303392 303392 0 0 lcc 0 0 7 7 2 2025-01-07 Lexis Nexis 225.25 0 KF 1183 .H43 2021 70000000906094 2025-05-14 13:38:12 225.25 2025-01-07 6