Topic: Contracting with Health Plans & Provider Networks
Collection of resources on contracting with health insurance plans, with an emphasis on leveraging the agency's role as an Essential Community Provider (ECP). Marketplace plans must include some ECPs in their provider networks.
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Webinars and Training
National Center for Innovation in HIV CareMay 2016
Case study showing how an organization transitioned from an HIV/AIDS housing organization to an agency with growing revenues in the health care field.
Training resources on enhancing billing systems to maximize revenues, covering CPT and ICD codes in the HIV/AIDS care context.
CRE TA CenterApril 2016
Tips for negotiating contracts with insurers.
Positive Outcomes and The George Washington UniversityMay 2013
Webcast (and slides) on what HIV medical clinics should consider in assessing readiness and preparing for or expanding participation in health insurance markets.
Tools and Job Aids
CRE TA CenterMay 2017
Tips to help Ryan White HIV/AIDS Program providers to take concrete steps to improve their contracting and billing processes.
CRE TA CenterMarch 2016
Tool for conducting a cost analysis: the process of determining the unit cost or the average cost of providing specific services over a defined period of time in order to use this information to bill and secure reimbursement for services provided.
CRE TA CenterJanuary 2016
Actions agencies can undertake to expand or establish contracts with Medicaid or Marketplace Insurance Plans. Tailored for Ryan White HIV/AIDS Program (RWHAP)-funded core medical provider managers or administrators.
CRE TA CenterSeptember 2015
Tool for assessing your organization’s strengths and gaps in areas that are of importance to insurers and that support maximizing revenue realized from contracting activities.
CRE TA CenterMarch 2015
This Roadmap can help you navigate resources that deal with contracting, billing and enrollment with Medicaid and Marketplace Insurance Plans.
TARGET CenterOctober 2013Collection of resources on compliance programs, which are an essential component of agency operations and entail mechanisms to ensure, for example, appropriate handling of payments, claims, and audits.
Positive Outcomes and The George Washington UniversityMay 2013Questions for a health provider to address when marketing its services to health insurance plans, with the goal of being added to the plan's provider network.
Feldesman Tucker Leifer Fidell LLPNovember 2012
Overview of managed care models, reimbursement methods, and insights on contracting with MCOs.
HRSA HIV/AIDS Bureau (HAB)January 2009
Workbooks to help Ryan White planning bodies and other entities self-assess their effectiveness. Each SAM is designed for use by a small ad hoc group.
Reports and Best Practices
Insights from a Health Center on how to negotiate with a health insurance plan to seek changes to their policies--specifically, a plan's policy that does not allow Infectious Disease Specialists to be listed as Primary Care Providers.