Managed Care
Managed care
Get answers to your questions about physician-rating systems
The Texas Medical Association has several tools available on physician-rating systems by Blue Cross and Blue Shield of Texas. The practice management page of their website provides information on what BCBSTX’s ratings mean, what you can do to contest your ratings, and how to improve your practice performance.
> What Can I Do About My BlueCompare/BlueChoice Solutions Ratings?
Managed care contract negotiation guide
To help members through the maze of managed-care contract negotiations, AAFP has developed a 12-page guide that takes members step-by-step through the process. Have your AAFP member number and password handy when you’re asked to log in.
> AAFP Contracting Guide (members only)
AAFP’s Health Plan Complaint form
Have a gripe about a managed care plan? Register your complaint with AAFP’s Health Plan Complaint form. You can fill out the form online or print it out as a PDF so that different members of your staff can complete sections that pertain to them. You can also view all of the complaints filed so far to see if other members are having similar problems. Data AAFP gathers through this form will be used to grade third party payers, so fill out forms on your payers and make your experience count.
> AAFP’s Health Plan Complaint form
Request bundling policies from managed care organizations
Under S.B. 418, the Prompt Pay bill from the 78th Legislature, health plans are required to disclose fee schedules along with any bundling logic that effects physician payment. Download a sample letter through the link below to send to health plans requesting payment policy and bundling guidelines.
> Sample fee disclosure request
AAFP protecting your interests
AAFP’s Private Sector Advocacy department represents family physicians’ interests to health insurance companies, medical specialty societies, and employers. Go to this section of AAFP’s website to see more on their work on your behalf in payment, pay-for-performance, physician measurement, tiered networks, administrative simplification, retail health clinics, and transparency.
> AAFP Private Sector Advocacy
Vaccine pricing
In the effort to improve payment rates for vaccinations, AAFP and the American Academy of Pediatrics have provided Model Contract Language for Vaccines that demonstrates what your managed care contracts should contain for proper reimbursement of vaccinations.