Contract with Health Plans in Miami and South Florida

It is the process of getting your practice entity accepted into a plan's network: a participation request, the plan's review of your group and providers, the proposed contract and fee schedule, and the signed agreement with an effective date. Overthink runs that process with each plan and keeps a log of where every contract stands.

Contracting is the agreement between the plan and your practice entity; credentialing is the plan's verification of each individual provider. Both must be complete before you can bill in-network, so we coordinate the practitioner credentialing alongside the contract.

It depends on what your current and prospective patients actually carry, and in Miami-Dade and Broward that often means Medicare Advantage plans and the managed care plans that run Florida Medicaid, in addition to commercial carriers. We review your patient mix and zip code and prioritize the plans worth pursuing.

It happens often in some specialties and zip codes. We check whether the plan accepts a request for an exception based on patient need or location, prepare that request with supporting information, and track the answer while continuing with the plans that are open.

We review the proposed rates and terms, point out what is negotiable and prepare the request for changes, and you decide what to accept. Final terms are always the plan's decision.

Your entity and NPI information, the list of providers with their licenses and CAQH profiles, your service address and a copy of any existing plan contracts so we know what is already in place. If the group still needs its organization NPI, we obtain it first.

Each plan sets its own review pace, and the timeline depends on whether the network is open, how complete the group and provider files are and whether credentialing runs in parallel. We explain what to expect for your specific plans in the first conversation and follow up so files do not sit idle.

Not automatically. Most plans treat a change of ownership or tax ID as a new contract or an assignment that must be approved, and each plan handles it differently. We notify the plans, prepare the assignment or new participation requests and keep the current contracts active while the change is reviewed.