About the service

With the increasing presence of managed care in the New Orleans marketplace, it is important for each physician to become more knowledgeable, from a legal perspective, of the basic tenets of managed care contracts. Professional legal review of all contracts is a sound and prudent business practice.

It is the goal of the Orleans Parish Medical Society, through development of the managed care contract review service, to assist physician-members in obtaining quality, timely legal advice concerning their provision of medical care entities and the legal ramifications of entering into contractual relationships.

For the purposes of this service, managed care entities or organizations are defined as health maintenance organizations, or preferred provider organizations.

A basic contract review is defined as a written evaluation of an individual OPMS-member physician's managed care contract, with easy-to-understand explanations of what his/her obligations would be under the contract, the acceptability of each provision and alternative language where appropriate.  Past this point, review of documents referred to in the contract, such as managed care organization's policies and procedures and/or utilization manual, and/or negotiation assistance are over and beyond the scope of the basic contract review.

About the process and fee

In order to receive information about participating firms, OPMS members may call the Society office at 523-2474.

Firms participating in the managed care contract review service have agreed to accept a fee of $300 for performing a basic contract review. This includes a written evaluation and phone consultation.

About the firms

Orleans Parish Medical Society, with the assistance of several local attorneys, established standards for the participation in this service.  These criteria include:

• each firm must strive to provide quality, timely service to each and every physician client;
• the firm must be located in the New Orleans metro area;
• the primary staff assigned to the contract review project have at least five years experience in health law;
• an attestation from the firm that health-related law comprises at least 1/3 of the total work performed by the attorneys assigned to the review service;
• each attorney assigned to the work must have a minimum of eight hours per year of continuing legal education in health law matters;
• each attorney must hold at least two professional association memberships in health-law related organizations;
• every engagement must be supervised and signed off by a partner in the health law practice;  and
• the firm must agree to accept the set fee for performing a basic contract review.