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AHLA Health Plans Contracting Handbook: A Guide for Payers and Providers (AHLA Members)

This classic work provides unparalleled practical coverage of the themes and trends in managed care contracting. It is filled with concise and detailed advice for addressing the issues that arise for both payers and providers in managed care network relationships.
Publisher: AHLA

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Print Book:1 Volume Softbound, 556 pages
8th Edition Includes Downloadable Content: zip
ISBN/ISSN: 9781663313867
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ISBN/ISSN: 9781663313874
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8th Edition
ISBN/ISSN: 9781663313874
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ISBN/ISSN: 9781663313867
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Real-life examples inform your negotiating and drafting.

The Handbook traces the managed care contracting process from preparing to negotiate the contract, to formation and implementation, to termination issues.

With contributions from more than twenty authors, the book includes nearly 300 sample clauses, many from the authors' own files. The clauses provide variations in language to illustrate potential advantages to the respective parties, as well as factors to consider when negotiating in today’s dynamic legal and business context. This practical work also includes checklists, a health plan contracting term glossary, and a fully annotated provider agreement template.

The latest trends and emerging issues.

The authors address emerging issues in managed care contracting, including:

  • Managed care penetration into Medicare and Medicaid
  • Value-based payments and the associated financial and operational considerations
  • Large health systems launching as independent payers or through integrated delivery models
  • The rise of direct-to-employer contracting
  • A growing need to address uses and ownership of data
  • Increasing focus on considerations when a provider does not have a contract with a payer
  • And more!

A jumping off point for further research

Throughout the book, the authors provide cites to cases or state statutes for further research into the state of the law as needed.

Editor-in-Chief: Robin Fisk
Editors: Christina DeGraff-Murphy and Gregory Mitchell
Authors: Gerald "Jerry" L. Aben, Matthew Amodeo, Adam C. Aseron, Brooke Bennett Aziere, John C.J. Barnes, James W. Boswell, Aimee DeFilippo, Lisa G. Han, Andrew C. Helman, John M. Kirsner, David E. Kopans, Mark S. Kopson, Kathrin E. Kudner, Jacqueline B. Penrod, Christian Puff, Michael F. Schaff, Debra Silverman, Andrew Stein, Leah B. Stewart, Adam C. Varley, Amanda M. Wilwert

For full bios, click here.

The 7th Edition ISBN was 9781632806130.

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Published March, 2021.


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Table of contents

 Recent Titles from the American Health Law Association 
About the Editors
About the Authors
About the American Health Law Association

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

Appendix A  Glossary of Health Plan Contracting Terms
Appendix B  Table of Sample Clauses
Appendix C  Physician Group Practice Provider Agreement Template with Commentary