Reference no: EM133293157

There are several key elements required in a health care provider's contract with a managed care organization (MCO). A typical contract between an MCO and a physician contains definitions, terms, obligations, and other features of payer-provider agreements. Terms and clauses are not expected to be changed, while payment terms that can be renegotiated should be placed in appendices. For this assignment, you are taking on the role of a provider relations manager at Allianta insurance company. You have an appointment with the practice administrator and physician leader at Ashford Medical Group (AMG), which is a multispecialty practice with 10 health care providers. Currently, AMG is not a participating provider at Allianta. The goal of this appointment is to recruit AMG to be an in-the-network provider at Allianta.

1. Using your own words, Examine two important common clauses in the contract: no balance billing and nondiscrimination. Please Cite and reference scholarly references below.

2. Using your own words, Analyze the importance of provider contracts in maintaining a provider network.

3. Using your own words, Explain network adequacy and its significance to health plan members.