Published September 27, 2018

Navigating and Negotiating Medicaid Managed Care Contracts

Q:  What do a television writer, producer, and personality; a Pulitzer-Prize-winning author; a doctor-turned-patient; and a PYA healthcare industry thought leader have in common?

A: They all spoke at the 2018 Iowa Hospital Association (IHA) Annual Meeting October 9-11, 2018, in Des Moines, IA.

PYA Principal Martie Ross engaged hospital leaders in her presentation, “Navigating and Negotiating Medicaid Managed Care Contracts.”  She examined how the negotiation of private managed care contracts focuses on the amount paid to the provider, while the primary focus in Medicaid managed care contracting is the manner in which the provider will be paid.

Martie’s session “identified key issues relating to the payment process and highlighted strategies to secure contract language to protect providers in light of apparent questionable practices by managed care organizations (MCOs) in other states.”  In addition, she:

  • Explained payment, utilization, and care coordination contracting terms.
  • Interpreted managed care contracting termination options, including notice requirements and continuity of care.
  • Outlined grievance, provider complaint, and appeals processes.
  • Discussed new amendments to the managed care contracting process.
  • Examined the process for pursuing a claim if an MCO violates a key contract provision.

View presentation below:

If you would like more information about how PYA can help navigate and negotiate Medicaid managed care contracts, or would like assistance in any manner involving compliance, valuation, or strategy and integration, contact one of our PYA executives below at (800) 270-9629.

Executive Contacts

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