Health Insurance Plan Network Provider Agreements (Commercial – Health Plan)

This practice note discusses provisions for agreements between health plans and doctors, dentists, and other healthcare professionals who provide services to plan members. It is intended as a guide for attorneys representing health plans who are asked to draft, review, or negotiate a provider agreement with providers who wish to participate in the health plan's provider network. It focuses on provider contracting for commercial plans and does not discuss provider agreements for Medicare Advantage or Medicaid managed care plans, which differ in substance from provider agreements for commercial plans. The practice note details the following elements: provider network development and contracting, provider manuals, compensation, billing and payment, network participation, provider licensing and insurance, provider credentialing, maintenance of records, termination, and state contracting and filing requirements.