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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Guidelines and Manuals
HRSA HIV/AIDS BureauFebruary 2015
HRSA HIV/AIDS Bureau's Affordable Care Act updates, policies, webinars, and documents.
Webinars and Training
CRE TA CenterJanuary 2015
This webinar provided an introduction to the National Technical Assistance (TA) Center for Contracting, Reimbursement and Enrollment with Medicaid and Marketplace Insurance Plans (CRE), a new HAB-funded cooperative agreement.
National Center for Innovation in HIV CareOctober 2014
Thousands of people living with HIV/AIDS are now eligible for insurance coverage thanks to the ACA. This webinar examines this and other changes brought about by the ACA, and offers guidance to Ryan White-funded ASOs and CBOs for navigating this changing policy environment and improving retention in care for their clients.
AETC National Resource CenterSeptember 2013
Practical suggestions for readying Ryan White agencies to transition from grant funds to health insurance reimbursement, including retention of HIV+ patients and gaining new patients through expanded health insurance enrollment.
Julia Hidalgo, Positive Outcomes and GWUMay 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 CenterMarch 2015
This Roadmap can help you navigate resources that deal with contracting, billing and enrollment with Medicaid and Marketplace Insurance Plans.
Tip sheet (update from April version) explaining how safety net providers can contact and seek contracts with health insurance plans as Essential Community Providers (ECPs), defined as providers with experience caring for medically underserved individuals.
Julia Hidalgo, Positive Outcomes and The George Washington UniversityMay 2013
Questions 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.
National Academy for State Health PolicyApril 2013
Tips for agencies in contracting with health insurance plans as Essential Community Providers (ECPs).
TARGET CenterMarch 2013
Steps agencies can take in setting up contracts with health insurers and provider networks.
Tips for Ryan White agencies in contracting with health plans and Medicaid Managed Care Organizations.
Feldesman Tucker Leifer Fidell LLPNovember 2012
Overview of managed care models, reimbursement methods, and insights on contracting with MCOs.
Guttmacher InstituteJune 2012
Three-part process for family planning centers in contracting with Medicaid and private health plans.
CDC and HRSA HIV/AIDS BureauJanuary 2002
Sample managed care purchasing specifications related to primary and secondary prevention and medical management of HIV/AIDS.
Reports and Best Practices
TARGET CenterJuly 2014
Suggested ways for providers to participate, plan, and make necessary changes as they implement the Affordable Care Act (ACA).
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.
Considerations for safety net providers in preparing for implementation of the Affordable Care Act (e.g., third-party billing, restructuring operations).