Health Insurance Plan Network Provider Agreements

Use this practice note from Practical Guidance – Healthcare to understand agreements between health plans and doctors, dentists, and other healthcare professionals who provide services to plan members;  gain insights into provider network development and contracting, provider manuals, compensation, billing and payment, network participation, provider licensing and insurance, provider credentialing, maintenance of records, termination, and state contracting and filing requirements. Consult this resource when drafting, reviewing, or negotiating a provider agreement with providers who want to participate in the health plan's provider network.

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Related Content

• Health Insurance Plan Network Provider Agreements Checklist (Commercial - Health Plan)
  Rely on this checklist when asked by health-plan clients to draft or review agreements with healthcare providers who would like to become part of a plan's provider network. Consider key legal and business points when preparing a provider agreement for use by a plan.
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  Learn about operational and regulatory compliance matters for healthcare discount plans. Advise clients on discount plan licensing and registration, marketing, reporting requirements, and the impact of the National Association of Insurance Commissioners (NAIC) Discount Medical Plan Organization Model Act on state regulation of discount plans.
• Healthcare Discount Plans Checklist
  Walk clients through discount plan operation and compliance matters using this point-by-point list of instructions. Locate relevant laws, identify applicable licensing requirements, and review and understand key aspects of plan operations, the regulatory reporting process, and evaluating recordkeeping policies and procedures.

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