In the managed care area, Boult Cummings attorneys focus their efforts exclusively on the representation of providers. Services provided fall into three categories: review of managed care agreements, formation and operation of provider networks, and representation in connection with payor disputes.

Managed care contract terms can have a significant impact on provider reimbursement. We regularly review and provide advice on managed care agreements for a broad cross section of provider clients, including hospitals, physician practices, imaging centers and provider networks. Our review focuses on making sure the terms of the contract protect the provider as much as possible from unfair payment denials and delays. We also review these agreements for compliance with applicable legal requirements, including, for example, state laws on prompt payment and retroactive denials.

A number of legal issues face providers forming a network for payor contracting. Decisions must be made on structure, governance and other organizational issues. In addition, great care must be taken to ensure that the network will operate in a manner consistent with federal antitrust laws. Our attorneys have experience in addressing all of these issues. We have assisted hospital clients in the formation of physician-hospital organizations ("PHOs"), and also worked with physician practices in organizing and operating physician networks. As part of our work for these provider network clients, we have frequently provided advice on the proper operation of a "messenger model" in order to comply with antitrust laws.

Providers and payors often end up in disagreements regarding payment issues. We have represented a variety of health care providers, including hospitals, physician practices, surgery centers and imaging centers, in resolving payment disputes through informal negotiation, and where necessary, through arbitration or litigation.