MANAGED CARE CONTRACTING MANIFESTO
CONTRACTING ETHOS AND EXPECTATIONS CONTRACTING ETHOS AND EXPECTATIONS PEDIATRIC MANAGED CARE ADVISORY BEHAVIORAL HEALTH & PRIMARY CARE
Payment for physician services for newborn care should be separately identified as unique and distinct from maternal services and should ensure adequate and clearly identified payment to attending physicians who provide care for newborn infants to ensure consistent and continuous coverage for the neonatal period and for subsequent pediatric care.
- Medicaid fees should be set at a rate that is at least 100% equivalent to those in Medicare.
- Health plans should use the most current version of CPT codes and adhere to CPT guidelines regarding the use of codes.
- American Medical Association. Current Procedural Terminology. Chicago, IL: American Medical Association
- Melzer SM, Reuben MS, American Academy of Pediatrics Section on Telephone Care and Committee on Child Health Financing. Payment for telephone care. Pediatrics. 2006;118(4):1768–1773.
- American Academy of Pediatrics Committee on Child Health Financing. Model contractual language for medical necessity for children. Pediatrics. 2005;116(1):261–262p.
- American Academy of Pediatrics, Committee on Child Health Financing. Medicaid policy statement. Pediatrics. 2005;116(1):274-280
- HealthCare.gov The Health Care Law and You. Available at: http://www.healthcare.gov/law/index.html.