The Law Office of Susan M. Erickson, PLLC
Based in Austin, Texas, The Law Office of Susan M. Erickson provides high-quality legal services in the areas of managed care, Medicaid managed care, Medicare Advantage plans, health insurance regulatory and general health law.
THE FIRM
Representative Practice Areas:
Health Care Contract Drafting/Editing/Negotiation
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Provider contracts with health plans, other payors, and ACOs, including value-based care arrangements
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Managed care delegation agreements with behavioral health, vision, dental, disease management, PBM, and medical transportation contractors, and delegated credentialing, UM and claims agreements
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Telemedicine, telehealth, and virtual care management agreements
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Third-party administrator and management services agreements
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Settlement agreements and single-case agreements between MCOs and health care providers
Managed Care Operations and Transactional Matters
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Holding company filings, including Form A acquisition statements for HMO/insurer changes of control, Form B and Form D affiliate agreement filings
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Licensure matters, product filings, network adequacy reviews, financial and quality of care audits, service area expansions, health care collaborative filings, out-of-network/balance billing dispute resolution matters, prior authorization and "gold carding" requirements, and financial regulation of MCOs.
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Advise on implementation of compliant processes for such areas as provider credentialing, utilization review, grievances and appeals, marketing and member communications, HIPAA/privacy policies, and new requirements from the Consolidated Appropriations Act of 2020.
Regulatory Analysis and Compliance; Interface with State and Federal Agencies
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Analysis and interpretation of state and federal regulations affecting health plans, plan sponsors, and health care providers, including federal and state Medicaid/CHIP regulations, CAA and Transparency in Coverage requirements, state insurance laws, and state scope of practice laws.
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Interpretation and education on Medicare Advantage and state Medicaid managed care contract requirements, reimbursement issues, deliverables and the impact of new regulatory directives
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Draft and file letter briefs in response to government open records requests