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Private Payers

Private insurance companies and their differing policies, procedures, and payments add complexity to medical practice today. These resources are intended to assist practices in dealing with private payers.

  • Evaluating Payment Contracts - AMA and RAND created two resources to help physician practices when evaluating bundled or episode-based and pay-for-performance agreements. (Note: Accessing these resources may require registration on the AMA site.)
  • Payer Contracting
    This slideshow details what should be included in any contract between a physician and payer.
  • Managed Care Legal Database – This comprehensive resource from the AMA identifies state and federal statutes and regulations that address common issues between private payers and physicians, including payment, coverage, contracts, network, and claims processing issues.  The database is searchable by state and by topic.
  • Optum Pay Payment Program
    United Healthcare now offers free downloadable payment information through Optum Pay ACH enrollment.