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MANAGED CARE CONTRACT REVIEW AND REVISION
Hospitals, physician groups, and other medical providers’ rights and remedies against commercial healthcare group plans and payers are defined in contacts entered into by and between these commercial healthcare plans and payers and the hospitals, physician groups, and other medical providers. These managed care contracts dictate rights involving commercial reimbursement, timeliness of such reimbursement, obligations of both parties, penalties for non-compliance, and other rights and remedies. Hence, it is of utmost importance to ensure that these contracts are reviewed from a legal perspective to assist with language pertinent to maximizing reimbursement, avoidance of insurance claims’ delays and denials of healthcare claims payment, clarification of patient obligations, and detailing other rights and remedies that are most relevant to the medical providers’ rights and remedies. Doing so can also protect patient rights. Ensuring that the medical provider has standing or the right to enforce the managed care contract is paramount to ensuring that the medical provider can enforce its rights to payment of claims and other legal remedies. In sum, Manziel Law Offices focuses on avoidance of delays and denials, timely claims payment and maximizing reimbursement through offering thorough and effective managed care contractual language that is as important as the patient’s healthcare plan policy document. In representing hospitals and other medical providers for more than three decades, Manziel Law Offices has the experience to recognize pitfalls in these contracts and to make the necessary contractual provision additions and revisions to protect the healthcare providers’ rights and remedies.