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Reference: https://www.ahip.org/courses/network-management-ahm530
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| Section | Objectives |
|---|---|
| Provider Contracting and Reimbursement | - Contract negotiation and terms - Value-based reimbursement models - Fee-for-service, capitation, and bundled payments |
| Utilization and Care Management | - Referral and authorization systems - Utilization management tools and techniques |
| Network Performance and Compliance | - Network performance metrics - Regulatory and accreditation requirements |
| Provider Credentialing and Oversight | - Quality monitoring and performance evaluation - Credentialing and re-credentialing processes |
| Network Structure and Design | - Types of provider networks (HMO, PPO, POS) - Network configuration strategies - Network adequacy and geographic coverage requirements |
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