Interested in training for your team? Click here to learn more

Negotiating Managed Care Agreements With Health Plans: Key Provisions, Anticipating Areas of Dispute, Court Treatment

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Tuesday, September 20, 2022

Recorded event now available

or call 1-800-926-7926

This CLE course will guide healthcare counsel on negotiating managed care agreements. The panel will discuss current trends in contract negotiations, key provisions in the agreements, recent court treatment, and practical tips for resolving common areas of dispute.


The past two years have brought many changes to the healthcare industry, impacting the relationship between providers and health plans. Negotiating favorable rates and terms in the new environment is more challenging than ever.

Recent litigation serves as a good reminder about the importance of negotiating managed care contracts, which govern the cost and quality of healthcare services between providers and patients. A recent decision from the California Court of Appeal, San Jose Neurospine v. Aetna Health of California (2020), held a miscoded bill was not a proper basis for the health plan to avoid payment. The court rejected the plan's argument that the provider's technical error precluded the provider from obtaining payment. It is important to anticipate potential areas of dispute when negotiating the managed care agreement, including the resolution of technical errors.

Counsel should carefully consider complex arrangements and take steps to reduce potential exposure for the provider of nonperformance of obligations under the agreement.

Listen as our authoritative panel of healthcare attorneys discusses negotiating managed care agreements with health plans. The panel will offer best practices for providers, examine current trends in contract negotiations, and discuss recent court treatment, key contract provisions, and ways to address common areas of dispute.



  1. Key provisions
    1. Definitions of payor, covered services, medical necessity, and standard of care
    2. Provider obligations
    3. Claims submission and reimbursement
    4. Retroactive claim adjustments
    5. Term and termination
    6. Other key provisions
  2. Anticipating areas of dispute
  3. Recent court treatment
  4. Practical tips for negotiating key contract provisions


The panel will review these and other important questions:

  • What are some approaches for providers' counsel in negotiating favorable provisions in managed care agreements?
  • What are the most commonly disputed issues during negotiations and ways for resolving them?
  • What are current trends in contract negotiations?


Malone, Kevin
Kevin J. Malone

Epstein Becker & Green

Managed care organizations trust Mr. Malone to help them understand and navigate their most difficult legal,...  |  Read More

Mitchell, Gregory
Gregory R. Mitchell

McDermott Will & Emery

Mr. Mitchell works with healthcare payors and providers to meet the full spectrum of their managed care and...  |  Read More

Access Anytime, Anywhere

Strafford will process CLE credit for one person on each recording. All formats include course handouts.

To find out which recorded format will provide the best CLE option, select your state:

CLE On-Demand Video