5 Managed Care Contract Questions Regarding Referral Requirements

Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these five questions regarding referral requirements within managed care contracts during negotiations.


1.    Do referral requirements, if any, properly explain the provider's obligations as they relate to other contracting and non-contracting facilities?

2.    Does the contract specify which party is liable for payment of services on referral and payment of transportation, if applicable?

3.    Does the contract permit subcontracting for services?

4.    Does the contract permit a contracting provider to a non-contracting provider?

5.    Does the contract in any way limit the provider from making the most appropriate referral?

More Articles on Managed Care Contracts:

8 Managed Care Contract Questions Regarding Utilization and Management

Managed Care Companies File Protests Over Lost Ohio Medicaid Contracts

10 Managed Care Contract Questions Regarding Payment

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