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Initiate Contract Process
Provides lessons learned, tips and Frequently Asked Questions (FAQs) about contracting with third-party payers. Also includes customizable timelines, checklists, tools detailing steps for provider credentialing and a sample contract. 
indicates recommended tool
Contracting Basics
| Tool description | Format |
|---|---|
| Ten Steps on Contracting with Insurance Companies *Updated! Features ten steps and corresponding tips for clinics beginning the contracting process. – STD TAC, 2016 |
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| Frequently Asked Questions about Contracts with Third-Party Payers *NEW! A list of ten frequently asked questions and corresponding answers about contracting with insurance companies. - Region I STD TAC, 2015 |
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| 4 Steps to Contracting with Health Plans & Provider Networks This document offers a concise, four-step outline to better understand and engage with the current contracting process with health insurers. – TARGET Center, 2013 |
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| Answers About Health Plan Contracting Webinar by representatives from America’s Health Insurance Plans and staff from health plans with a national presence. Explains health plan requirements, expectations for network providers, as well as what will make Essential Community Providers most attractive to health plans looking to grow their networks. - Family Planning National Training Centers |
Link |
| Working Successfully with Health Plans: An Imperative for Family Planning Centers Report that highlights an expert panel meeting that explored the challenges family planning centers face in contracting with Medicaid and private health plans. – Guttmacher Institute, 2012 |
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| Suggestions for Speaking to Insurance Representatives Suggested script for speaking with private insurance contract representatives. Login for free to access the resources. – Kern County via NACCHO, 2014 |
Link |
| Model Contract Originally adapted from the American Medical Association, this is a model health insurance physician contract. Login for free to access the resource. – Washington State Medical Association, 2003 |
Link |
Credentialing
| Tool description | Format |
|---|---|
| Provider Credentialing: Overview and Checklist Provider credentialing is a prerequisite for contracting. This document describes the basics of credentialing, including resources and a checklist to manage submission of background information. – Region I STD TAC, 2014 |
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| Provider Credentialing Tracking Workbook *NEW! This workbook allows you to easily track re-credentialing dates for third-party payers (TPPs) and individual provider documents (such as licenses and CMEs) that must be kept up-to-date for credentialing purposes. – Region I STD TAC, 2015 |
Excel |
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How to Credential Providers with Health Plans
Provides overview of how to credential providers with health plans. -Family Planning Training Centers, 2014
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Link |
| Tips for Credentialing Providers *NEW! These tips provide guidance for credentialing providers and keeping credentialing information current. – Region I STD TAC, 2015 |
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| Contractual Obligations Tracking Spreadsheet *NEW! For clinics with multiple third-party payer contracts, this tool helps track contractual obligations and communicate them with staff and patients. – Region I STD TAC, 2015 |
Excel |
