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.
Guidelines and Manuals
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HRSA HIV/AIDS BureauDecember 2016
HRSA’s HIV/AIDS Bureau guidance and requrements for grantees of the Ryan White HIV/AIDS Program on such topics as eligibility, allowable use of funds, and clarifications of legislative requirements.
Webinars and Training
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CRE TA Center, National Center for Innovation in HIV CareMay 2016
Strategies for getting ready to bill and the systems you need in place to get started.
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National Center for Innovation in HIV CareMay 2016
On this webinar, representatives from Bailey House present a case study showing how their organization transitioned from an HIV/AIDS housing organization to an organization with growing revenues in the healthcare field.
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HealthHIVMay 2016
Training resources on enhancing billing systems to maximize revenues, covering CPT and ICD codes in the HIV/AIDS care context.
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CRE TA CenterApril 2016
Tips for negotiating contracts with insurers.
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CRE TA CenterFebruary 2016
Medicaid managed care organizations and commercial health insurers are rapidly adopting innovative strategies to address the care management and social support needs of HIV positive and other beneficiaries.
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CRE TA CenterFebruary 2016
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CRE TA CenterJune 2015
This webinar highlighted a new resource outlining eight essential actions to assist providers establish or expand contracts with Medicaid and Marketplace Insurance Plans. P
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CRE TA CenterJanuary 2015
This webinar provided an introduction to the National Technical Assistance (TA) Center for Contracting and Reimbursement Expansion with Medicaid and Marketplace Insurance Plans (CRE), a new HAB-funded cooperative agreement.
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The Affordable Care Act: Implications for AIDS Service Organizations and People Living with HIV/AIDS
National Center for Innovation in HIV CareOctober 2014Thousands 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.
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Positive Outcomes and The George Washington UniversityMay 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
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CRE TA CenterMay 2017
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CRE TA CenterMarch 2016
This tool is designed for staff that administer or manage the delivery of RWHAP-funded core medical services to help ensure their organization is able to adequately bill and be reimbursed for providing vital health care services to their clients.
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CRE TA CenterSeptember 2015
Tool for assessing your organization’s strengths and gaps in areas that are of importance to insurers and that support maximizing revenue realized from contracting activities.
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CRE TA CenterJune 2015
For RWHAP core medical provider managers or administrators who provide oversight for the delivery of services to persons living with HIV and want to expand or establish contracts with Medicaid or Marketplace Insurance Plans.
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CRE TA CenterMarch 2015
This Roadmap can help you navigate resources that deal with contracting, billing and enrollment with Medicaid and Marketplace Insurance Plans.
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TARGET CenterOctober 2013
Collection of resources on compliance programs, which are an essential component of agency operations and entail mechanisms to ensure, for example, appropriate handling of payments, claims, and audits.
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HIVMAJune 2013
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.
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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.
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National Academy for State Health PolicyApril 2013
Tips for agencies in contracting with health insurance plans as Essential Community Providers (ECPs).
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TARGET CenterMarch 2013
Steps agencies can take in setting up contracts with health insurers and provider networks.
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HIVMAMarch 2013
Tips for Ryan White agencies in contracting with health plans and Medicaid Managed Care Organizations.
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Feldesman Tucker Leifer Fidell LLPNovember 2012
Overview of managed care models, reimbursement methods, and insights on contracting with MCOs.
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Guttmacher InstituteJune 2012
Three-part process for family planning centers in contracting with Medicaid and private health plans.
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CDC, HRSAJanuary 2002
Sample managed care purchasing specifications related to primary and secondary prevention and medical management of HIV/AIDS.
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HRSA HIV/AIDS Bureau
Workbooks to help Ryan White planning bodies and other entities self-assess their effectiveness. Each SAM is designed for use by a small ad hoc group.
Reports and Best Practices
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CommunityCareMay 2014
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.
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NASTADApril 2013
Resource bank of best practices in third party billing and reimbursement, compiled from health departments, safety net providers, and others.
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MosaicaAugust 2012
Considerations for safety net providers in preparing for implementation of the Affordable Care Act (e.g., third-party billing, restructuring operations).