Description

This unit, "Contract Structure and Key Terms," aims to provide learners with a practical understanding of the foundational structure and terminology within healthcare payer-provider contracts. It covers key sections such as definitions, scope of services, fee schedules, reimbursement clauses, audit rights, and dispute resolution mechanisms. Special attention is given to interpreting critical terms like "allowed amount," "clean claims," "medical necessity," and "termination clause." The unit also explores the strategic implications of contract elements like performance metrics and clean claim obligations, and how each clause contributes to overall contract performance, legal defensibility, and operational efficiency through the analysis of annotated contracts.