Managed Care Contract Quick Reference Sheet

Managed care plans provide benefits to subscribers (or enrollees) who are required to receive services from network providers (physicians or health care facilities under contract to the managed care plan). Network providers sign contracts with the managed care organization, and subscribers are generally required to coordinate health care services through their primary care physician (PCP). Managed care is categorized according to six models:

1. Exclusive provider organization (EPO)

2. Integrated delivery system (IDS)

3. Health maintenance organization (HMO)
a. Direct contract model
b. Group model
c. Individual practice association (IPA)
d. Network model
e. Staff model

4. Point-of-service plan (POS)

5. Preferred provider organization (PPO)

6. Triple option plan

Physician offices create a managed care plan quick reference sheet as a resource for identifying health care services that require preauthorization and expediting claims completion and submission. The information located on a managed care plan quick reference sheet is based on significant provisions contained in each managed care health plan contract, and the original contract should be referenced for details about such provisions.

INSTRUCTIONS

Prepare a managed care plan quick reference sheet in Excel comparing the six models. What information would be helpful on this reference sheet? You are at liberty to choose your own categories but must include preauthorization requirements as 1. List at least 4 additional categories.

Prepare a separate Word document explaining the purpose of the quick reference sheet.