Managed Care Contracting
The attorneys at Wolfe | Pincavage regularly represent hospitals, large physician organizations, and a variety of other healthcare providers in structuring and negotiating their relationships with health plans, preferred provider organizations and other third-party payors. We regularly counsel providers on termination of their managed care relationships as well as negotiation of new or amended relationships. We understand the ever-changing health insurance industry and its unique regulatory requirements and provide up-to-date advice on a wide-range of topics including downstream Medicaid and Medicare requirements, value-based contracting, prompt pay laws, utilization review and audits, credentialing, and pricing transparency issues.
With years of experience in resolving healthcare payment disputes, we know what managed care contract provisions must be included to limit exposure to risk, maximize clients’ bottom line, and decrease administrative burden. We provide clients with creative strategies to optimize managed care relationships and business operations.
Wolfe | Pincavage has reviewed numerous HMO, PPO, commercial, transplant, behavioral health, dental, vision, and third- party payors contracts involving almost every health plan and insurer. Our vast experience negotiating managed care contracts allows us to provide clients with health plan specific strategies that streamline the contracting process.