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 Representative Practice Areas:

Health Care Contract Drafting/Editing/Negotiation

  • Provider contracts with health plans, other payors, and ACOs, including value-based care arrangements

  • Managed care delegation agreements with behavioral health, vision, dental, disease management, PBM, and medical transportation contractors, and delegated credentialing, UM and claims agreements

  • Telemedicine, telehealth, and virtual care management agreements

  • Third-party administrator and management services agreements

  • Settlement agreements and single-case agreements between MCOs and health care providers

 

Managed Care Operations and Transactional Matters

  • Holding company filings, including Form A acquisition statements for HMO/insurer changes of control

  • 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, and financial regulation of MCOs.

  • Advise on implementation of compliant processes for such areas as provider credentialing, utilization review, grievances and appeals, marketing and member communications, and HIPAA/privacy policies.

 

Regulatory Analysis and Compliance; Interface with State and Federal Agencies 

  • 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.

  • Interpretation and education on Medicare Advantage and state Medicaid managed care contract requirements, reimbursement issues, deliverables and the impact of new regulatory directives

  • Draft and file letter briefs in response to government open records requests

 

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