Third-Party Payers

Third-party payers represent a growing source of potential revenue for many publicly funded family planning providers. As a result, it is increasingly important to health center sustainability that providers are able to enter into contractual relationships with third-party payers.

NFPRHA's Work

NFPRHA provides resources for family planning providers to use during the contracting and credentialing processes with third-party payers. NFPRHA also advocates on the federal level to ensure that network adequacy requirements, including the requirements that health insurance companies contract with essential community providers (ECPs), are protective and inclusive of family planning providers. 

Resources

• Best Practices in Contract Management (PDF) – An overview of the process by which providers initiate and renegotiate contracts with third-party payers (October 2015).
  
  
• Contract Review Checklist (PDF) – An overview of the steps providers should take when reviewing a payer’s contract and conducting a negotiations process (October 2015).
  
  
• Sample Contract Engagement Letter (PDF) – A sample communication for a safety-net family planning provider to use when initiating a negotiations process with a third-party payer (October 2015).
  
  
• Sample Payer Appeal Letter (PDF) – A sample communication for a health care provider to use when appealing claims denied by a third-party payer (October 2015).
  
  
• Building Blocks for Effective Relationships with Third-Party Payers & workbook (PDF) - Examines the development of successful relationships with third-party payers as experienced by three different organizations (October 2014). 
  
  
• Provider Credentialing for Third-Party Payers (PDF) – An overview of the process by which providers are credentialed with third-party payers (September 2013). 
  
  
• Interested Parties Memo: Access to Family Planning Services in Medicaid Managed Care (PDF) – A summary of regulations pertaining to the ability of Medicaid beneficiaries covered by a managed care organization to access family planning services (December 2015).

For additional resources & information, access NFPRHA fact sheets and federal comments by issue or read NFPRHA's publications and recent press statements.