AHLA Health Plans Contracting Handbook: A Guide for Payers and Providers (Non-Members)
Select a format
Select subscription type
Terms & conditions
Subscribers receive the product(s) listed on the Order Form and any Updates made available during the annual subscription period. Shipping and handling fees are not included in the annual price.
Subscribers are advised of the number of Updates that were made to the particular publication the prior year. The number of Updates may vary due to developments in the law and other publishing issues, but subscribers may use this as a rough estimate of future shipments. Subscribers may call Customer Support at 800-833-9844 for additional information.
Subscribers may cancel this subscription by: calling Customer Support at 800-833-9844; emailing email@example.com; or returning the invoice marked "CANCEL".
If subscribers cancel within 30 days after the product is ordered or received and return the product at their expense, then they will receive a full credit of the price for the annual subscription.
If subscribers cancel between 31 and 60 days after the invoice date and return the product at their expense, then they will receive a 5/6th credit of the price for the annual subscription. No credit will be given for cancellations more than 60 days after the invoice date. To receive any credit, subscriber must return all product(s) shipped during the year at their expense within the applicable cancellation period listed above.
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 9781632806147.
eBooks, CDs, downloadable content, and software purchases are noncancelable, nonrefundable and nonreturnable. Click here for more information about LexisNexis eBooks. The eBook versions of this title may feature links to Lexis+® service for further legal research options. A valid subscription to Lexis+ or Lexis is required to access this content.
Published March, 2021.
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