000			03556 a2200361 4500
003			PUCPR
005			20250306143405.0
008			121224s2021 dcua frf 001 0 eng d
020			_a9781663313881 _qpaperback
040			_aPUCPR _beng _erda
041			_heng
049			_acicres
050			_aKF 1183 _b.H43 2021
110			_aAmerican Health Law Association _9302004 _eauthor.
245	1		_aHealth plans contracting handbook : _ba guide for payers and providers / _cAmerican Health Law Association
250			_aEighth edition
264			_aWashington, D.C. : _bAmerican Health Law Association, _c©2021
300			_axxxiii, 524 pages ; _c27 cm.
336			_atext _btxt _2rdacontent
337			_aunmediated _bn _2rdamedia
338			_avolume _bnc _2rdacarrier
500			_aIncludes index: p. 499 - 524.
504			_aIncludes bibliographical references.
505			_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.
520			_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.
650		0	_aMedical care _9134381 _zUnited States
650		0	_aHealth insurance _9109215 _zUnited States
650		0	_aInsurance contracts _9115146 _zUnited States
700			_aFisk, Robin _9301840 _eeditor in chief.
700			_aDegraff-Murphy, Christina _9302037 _eeditor.
700			_aMitchell, Gregory R. _9302038 _eeditor.
942			_c6 _2lcc
999			_c303392 _d303392