MANAGED CARE CONTRACTING

The LRPHO offers the following managed care contracting opportunities for its members.  This includes delegated credentialing on behalf of these healthplans, therefore members do not have to complete a separate credentialing application.

List of Payers

  • Aetna
  • Aetna Medicare Advantage
  • BestCare
  • Choicecare
  • CIGNA
  • Coventry
  • First Health
  • Gilsbar
  • Humana Commercial
  • Humana Medicare PPO
  • Humana Gold Plus
  • Humana Medicaid
  • MultiPlan
  • PCHS
  • Plan Vista
  • PPO Plus
  • PPO UHC-GEHA
  • UHC Commercial
  • UHC Medicare Advantage
  • UHC Medicaid

List of Payers

  • Aetna
  • Aetna Medicare Advantage
  • BestCare
  • Choicecare
  • CIGNA
  • Coventry
  • First Health
  • Gilsbar
  • Humana Commercial
  • Humana Medicare PPO
  • Humana Gold Plus
  • Humana Medicaid
  • MultiPlan
  • PCHS
  • Plan Vista
  • PPO Plus
  • PPO UHC-GEHA
  • UHC Commercial
  • UHC Medicare Advantage
  • UHC Medicaid

As a reminder, upon receipt of a new contract offering, each member may:

  1. Enroll in the contract by completing and returning the “enrollment form” to the LRPHO.
  2. Decline the contract offering
  3. Ask the LRPHO to messenger a “counter offer” on specific codes to the payer.
    • The request must be submitted to the LRPHO, in writing, on the member’s office letterhead.
    • The request must clearly identify the payer(s) to whom the member would like the “counter offer” to be messengered.
    • The request must include a list of the individual CPT codes and the requested revised rate(s).

The LRPHO will messenger the counter offer to the specific payer. The payer may then choose to:

  1. Accept the messengered counter offer.
  2. Submit a counter offer through the LRPHO for the member’s consideration
  3. Decline the messengered counter offer.

As always, providers/groups remain free to contract directly with any payer.