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NC Medicaid Managed Care: Provider-Prepaid Health Plan Contract Issues and Potential for Disputes

11:55      Welcome and Introductions

12:00      NC Medicaid Managed Care: Provider-Prepaid Health Plan Contract Issues and Potential for Disputes

Marcus C. Hewitt, Fox Rothschild LLP, Raleigh

Review the timeline of the transition to and implementation of Medicaid Managed Care in North Carolina, and explore common issues in PHP-provider network contracting, and likely areas where providers may have difficulty. This presentation discusses a potential for PHP-provider disputes, dispute resolution, and factors that may influence disputes and PHP networks. Topics include rates, key contract terms, dispute resolution procedures, claim denials, member and provider appeals, and factors that may influence contracting and the resolution of disputes.

1:00        Adjourn

Thank you

Thank you for joining us for NC Medicaid Managed Care: Provider-Prepaid Health Plan Contract Issues and Potential for Disputes.

Description

Review the timeline of the transition to and implementation of Medicaid Managed Care in North Carolina, and explore common issues in PHP-provider network contracting, and likely areas where providers may have difficulty. This presentation discusses a potential for PHP-provider disputes, dispute resolution, and factors that may influence disputes and PHP networks.

Topics include rates, key contract terms, dispute resolution procedures, claim denials, member and provider appeals, and factors that may influence contracting and the resolution of disputes.

Contributors

  • Marcus C. "Marc" Hewitt

    Marcus C. "Marc" Hewitt is a partner in the Raleigh office of Fox Rothschild and has practiced in the areas of health care and administrative litigation for almost 20 years. His practice focuses on administrative litigation, regulatory matters and a variety of commercial and business disputes. He represents hospitals, dialysis providers, diagnostic service providers, nursing facilities and other private providers and handles commercial disputes in state and federal courts, as well as state administrative litigation matters including Certificate of Need (CON) matters, licensure matters, and state government contract matters for external quality review organizations (EQROs) and Medicaid Prepaid Health Plans.

    Marc also advises health care providers and related entities such as dental support organizations (DSOs) and HMOs on regulatory compliance, contracting and related issues before the North Carolina Department of Health and Human Services, professional licensing boards and North Carolina Department of Insurance.

    Marc earned his B.A., with distinction, in Economics from the University of North Carolina at Chapel Hill and his J.D. from the University of North Carolina School of Law.

    Click here for more information about Marc.

November 17, 2021
Wed 11:55 AM EST

Duration 1H 5M

This live web event has ended.

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