decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Contracts and Contract Negotiations / Administrative Issues - Review Billing, Patient Verification Provisions
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Article Overview
This short article discusses practical administrative issues to review before entering or renewing a managed care contract. It focuses on the billing formats and submission requirements the plan expects, how patient membership or eligibility is verified, and what to look for in the plan’s annual report regarding key personnel and operational structure. The content is useful for practices evaluating contract feasibility and workflow impact.
Why This Topic Matters
Administrative contract terms can affect billing efficiency, patient registration accuracy, and overall practice operations. Understanding these provisions helps providers assess whether a managed care arrangement fits their existing systems and staffing.
What You Will Learn
- What administrative contract provisions should be reviewed before accepting a managed care arrangement.
- How billing format and submission workflow considerations can affect practice operations.
- Why patient membership verification processes matter for reducing claim and registration problems.
- What types of organizational and personnel information may be worth reviewing in a plan’s annual report.
Who Should Read This
- Physicians and group practices
- Medical office managers
- Billing and coding staff
- Practice administrators
- Managed care contract reviewers
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