Stites & Harbison, PLLC

Managed care continues to have a tremendous impact on health care. Our health law practitioners provides a full range of services related to managed care arrangements including all aspects of HMO and PPO development, acquisition and sale, managed care joint ventures, independent practice associations (IPAs) and physician-hospital organizations (PHOs). Stites & Harbison's services include determination of appropriate structures and business forms; preparation of contracts with providers and payors; preparation of contracts with Medicare and federal employees; review of fraud and abuse, Stark, and reimbursement issues; insurance regulatory compliance and other state department of insurance matters; and securities exemptions, offerings and registration matters.

• Drafting and Negotiating Managed Care Contracts (e.g., Preferred Provider Arrangements, Participating Provider Agreements, Network Access Agreements, etc.)
• Form Filings with State Departments of Insurance
• Administrative Proceedings Before State Departments of Insurance
• Development of Internal Policies and Procedures for HMOs, PPOs, and Other Health Insurers (e.g., Utilization Review, Internal Appeal and Grievance Procedures, etc.)
• Federal Regulatory Law Impacting Health Insurance and Managed Care (e.g., HIPAA, ERISA, COBRA and Medicare Part D)
• Represent Managed Care Clients in Mergers and Acquisitions