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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

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. Hewitt

    Marcus C. Hewitt is a partner at Fox Rothschild LLP in Raleigh. Marc is an experienced health care and litigation attorney focusing on administrative litigation, health care disputes and regulatory matters, and represents health care providers in a variety of commercial and business disputes.

    Marc handles numerous Certificate of Need (CON) matters for hospitals, dialysis providers, nursing and assisted living facilities, diagnostic service providers and other private providers, involving a variety of services and facilities. He represents clients in a variety of regulatory disputes including false claims act, Medicaid clinical coverage policies, Medicare cost reporting, licensure and certification, provider enrollment disputes, appeals and settlement of post-payment audits and recoupment, and others.

    Marc also advises health care providers on regulatory compliance and related issues before the North Carolina Department of Health and Human Services and Department of Insurance, including managed care, formation and compliance of HMO entities, joint ventures, fraud and abuse, licensure and others.

    Marc also works on health care-related commercial and business disputes, including those involving contract, unfair business practices, fraud and intra-company disputes. Among others, Marc has represented providers in civil disputes over hospital management and financing agreements, medical billing and reimbursement, medical staff matters, diagnostic imaging services and failed implementations of electronic health records (EHR) and practice management systems.

    Marc was a partner and Health Care Practice Leader at Smith Moore Leatherwood LLP, which combined with Fox Rothschild in 2018. Before private practice, he served as a judge advocate in the U.S. Marine Corps from 1996 to 2000.

    Marc is a member of the North Carolina Society of Healthcare Attorneys and the Health Law Section of the North Carolina Bar Association, and served as President of the North Carolina Society of Health Care Attorneys from 2013 to 2014.

    Marc earned his B.A. in Economics, with distinction, from the University of North Carolina at Chapel Hill in 1993 and his J.D. from the University of North Carolina School of Law in 1996.

    Click here for more information about Marc.

November 17, 2021
Wed 11:55 AM EST

Duration 1H 5M

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