Managed Care – Healthcare Wiki

35 States with Any Willing Provider laws

29 Jun 202329 Jun 2023 HealthcareWiki

As a provider, if your request to join a payer network in the following markets has been denied, you might have some recourse for appeals.

Administrative Work Data Tools Databank Managed Care Maryland Network Management Policies & Procedures Resource Toolkits

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

20 May 202320 May 2023 HealthcareWiki

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

Capitation Data Tools Databank Florida Managed Care Medicaid Medicare Advantage Special Needs Plans (D-SNPs)

Comprehensive Medicaid Actuarial Data (FL)

5 May 202315 Jun 2023 Alex Yarijanian

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

California Data Tools Databank Managed Care Medicaid

Medi-Cal Managed Care Enrollment Report

5 May 20236 May 2023 HealthcareWiki

This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.

California Data Tools Databank Managed Care MCO Outcomes

Medi-Cal Managed Care Quality Improvement Reports (CA)

25 Apr 202330 Apr 2023 Alex Yarijanian

Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual health plan reviewed.

Contracting Managed Care Payers templates Toolkits

Eligibility: Contract Language (Payer v Provider) and Sample to Use

6 Apr 202319 Apr 2023 HealthcareWiki

Eligibility: Contract Language (Payer v Provider) and Sample to Use.

Business Connected Care Contracting Databank Digital Therapeutics Funding HEDIS Managed Care Payers Press Reimbursement Startups Subcontracting Value Based Care virtual health Virtual Specialty Care

Health Insurance Providers’ Actions Concerning Mental Health

26 Nov 202230 Apr 2023 Alex Yarijanian

Academy Databank Legal Managed Care

Toolkit Managed Care Resource

16 Oct 202212 Feb 2023 Alex Yarijanian

The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination. The Database also contains relevant AMA policy, issue briefs, advocacy resources, model legislation, and a State Laws Map.

Contracting Managed Care No Surprises Act Payers

NEW RULES:Bans on balance billing and out-of-network cost-sharing

15 Mar 202215 Mar 2022 HealthcareWiki

Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No Surprises Act, which is included within the Consolidated Appropriations Act of 2021 (the CAA), provides the following:

California Managed Care Value Based Care

Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage

26 Feb 2021 Alex Yarijanian

Carenodes Health Enterprise
Office of the Executive

Dear Health Plan Representative,

Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.

Category: Managed Care

35 States with Any Willing Provider laws

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Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

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Comprehensive Medicaid Actuarial Data (FL)

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Medi-Cal Managed Care Enrollment Report

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Medi-Cal Managed Care Quality Improvement Reports (CA)

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Eligibility: Contract Language (Payer v Provider) and Sample to Use

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Health Insurance Providers’ Actions Concerning Mental Health

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Toolkit Managed Care Resource

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Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage

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Category: Managed Care

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