Fourth Edition, AMA Model Managed Care Contract (2005)

Unfair managed care contracts continue to be the source of many complaints and problems physicians have with health insurers and payers. The AMA's Private Sector Advocacy unit has updated the AMA Model Managed Care Contract (PDF, 453KB, requires Adobe® Reader®) to reflect legal and other developments in the marketplace since 2002, including developments in the area of external review, "all products" provisions, credentialing and fee-for-service arrangements. The contract includes 10 supplemental discussion pieces.

Click on the links below to obtain your free copy of the newly revised contract in its entirety, or click on the supplements below to obtain information about a specific issue.

Fourth Edition, AMA Model Managed Care Contract (PDF, 857KB)

Supplement 1 - Medical Necessity and Due Process (PDF, 167KB)

Supplement 2 - "All Products" Provisions (PDF, 166KB)

Supplement 3 - Fee-For-Service Payment Provisions (PDF, 171KB)

Supplement 4 - Coordination of Benefits (PDF, 140KB)

Supplement 5 - Late Payment of Claims (PDF, 165KB)

Supplement 6 - Retrospective Audits (PDF, 164KB)

Supplement 7 - Subrogation (PDF, 135KB)

Supplement 8 - Termination "Without Cause" (PDF, 138KB)

Supplement 9 - Dispute Resolution: Litigation vs. Arbitration (PDF, 162KB)

Supplement 10 - Restrictions and Obligations Post-Termination (PDF, 138KB)