Managing Managed Care Contracts

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
July 31st, 2014

It is apparent as the healthcare changes so does Managed Care contracts. You need to be more aware, they are more complex than ever and can be confusing, take heed as you enter into a new contract as a participating provider. Below are just a few issues to be sensitive to and is in no way inclusive of everything you need to be aware of.

 If you are a Member of the AMA, you may want to consider the National Managed Care Contract (NMCC) Database as a resource. This tool produced by the AMA is designed to ensure managed care contracts comply with the managed care laws of all 50 states, and are not one sided. They will also assist you in your negotiation of Managed Care Contracts. Visit NMCC here.

Be sure to educate your office staff to ensure contractual agreements are being followed as well. If you are unaware of your contractual obligations on previously signed contracts don’t hesitate to contact your provider representative. Keep in mind some of your previous contracts may have addendums you agreed to by not disagreeing.

My final suggestion: Physicians should seek advice from an attorney with experience representing physicians prior to signing a managed care contract!

Managing Managed Care Contracts. (2014, July 31). Find-A-Code Articles. Retrieved from

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