Claims Processing

Fair contracting


The AMA believes that insurers should abide by fair business and contracting principles. The AMA has created resources to help assist state advocates in their efforts to address insurer–physician contracting issues and to promote fairness in the contracting process. 

The AMA National Managed Care Contract database helps physicians and their advocates to navigate the intricacies of managed care contracts and determine the best state laws related to managed care contracting. The database includes text from the managed care laws of all 50 states and the District of Columbia, as well as federal requirements. Issue briefs on important managed care topics and AMA policies on specific managed care issues are also included.

Rental network PPOs are entities whose business practices focus on brokering physician discounted rates. The rental network PPO develops provider panel and then leases its panel and associated provider discounts to various payers. These discounts often find their way to a very broad range of entities without prior approval from the physician, and often times without any notice, robbing the physician of rightful reimbursement and corrupting the integrity of the PPO agreement.

The AMA believes the rental network PPO market must be fair and transparent and “silent PPOs” and other unauthorized entities should not be allowed to access rental network PPO contract discounts.

The AMA worked extensively with the National Conference of Insurance Legislators to develop a model bill to improve transparency in the rental network market.

Please contact Emily Carroll, JD, senior legislative attorney, with any questions: [email protected].