| Managed
Care Contract Cataloging |
|
Managed
Care Contracts (between Managed Care
Organizations and Health Professionals/Clinical
Providers/Physicians) are a critical
part of the modern managed care system.
Such contracts are crucial to the
professional and financial health
of the Health Care Provider.
A Managed Care Contract is a service
level agreement that establishes the
legal standards and service duties
of the MCOs towards the Physicians.
It also specifies how the Providers
would be paid, their right to dispute
decisions and most importantly, the
ability to manage the patient in a
professionally ethical fashion.
A Managed Care Contract articulates
the following:
 |
The rights and responsibilities
of parties to the agreement |
|
Flow of funds
and assignment of critical administrative
responsibilities |
|
The rules of
conduct |
|
The level and
type of healthcare |
Our Service
Scope
The present
service rendered by Datamatics Technologies
is the scrutiny and indexing of actual
signed contracts vis-à-vis
the AMA (American Medical Association)
template. The sequence of process
is as follows:
|
Receiving of the contract documents
form the customer |
|
Checking of
Actual Contract with AMA model
contract and its corresponding
clauses |
|
Creating a comparison
document depicting each clause
of actual contract against AMA
and presenting gap analysis |
|
A summary document
is created after thorough browsing,
which captures pertinent, client
specified details of the contract.
Details such as Provider name,
Details, Payment terms, Dispute
Resolution etc. are entered
with remarks if any |
|
The Comparison
document and the summary documents
are provided with hyperlinks
for toggling between these two
documents |
|
A quality check
process is performed on both
these documents before dispatching
to the customer |
Following crucial questions are clarified
by providing this service to providers:
|
Are there any blank spaces in
the contract or its schedules?
|
|
Has the procedure
for giving notice been stated?
|
|
Does the contract
constitute the entire agreement
between the parties? |
|
Is there a provision
for the recovery of attorneys'
fees in case of a dispute? |
|
Is the choice
of law favorable to the physician
or payer? |
|
What happens
if services are interrupted
or discontinued? |
|
Are there any
reinsurance provisions in the
contract? |
|
|
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