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Picking The Right Contract Type

December 29, 2016

CRE TA Center

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Tips on preparing the type of contract that best fits your organization's needs.

Two Main Types of Contracts

  • Group Contract - Contract with an individual provider at your organization who oversees other staff providing direct services to clients, usually a medical director or health officer. The contract is in the name of this person; individuals providing services at the organization would still need to be credentialed and have their National Provider Identifier (NPI).
  • Organization Contract - Contract with your organization and not an individual provider. You can easily add individual providers within your organization to the contract; however, in some states you may need to credential all of your individual providers before the insurer will contract with your organization. This contract type allows you to avoid having to get a new contract if the person named in the group contract leaves. When contacting an insurer, ask them if you can have an ancillary or location-based contract.

Contact the insurer to learn more about what the requirements are for the type of contract your organization is seeking. Remember, most health insurers maintain provider websites that summarize the contracting and credentialing process and provide commonly used forms.

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