Managed Care

Butler Tibbetts represents managed care organizations in a range of reimbursement and payor matters. Our experienced team of litigators handles disputes in all segments, including Medicare Advantage plans, Medicaid managed care plans, and HMO and PPO plans. Our team represents clients in contract negotiations, disputes and dispute resolution, audits and investigations, administrative proceedings, appeals, arbitrations, mediations.

We also help clients mitigate and manage exposure by providing guidance on operational, regulatory, and compliance matters. Our significant business and litigation experience in managed care and healthcare law provides tangible value in identifying and remediating potential controversies and issues before they occur.

How Can We Help?

  • Claims and processing analysis
  • Claims and appeals
  • Coverage denials
  • Downcoding and bundling
  • Fraud and abuse investigations and defense
  • Improper coding, processing and/or pricing of claims
  • Independent dispute resolution
  • Medicare, Medicaid, and third-party reimbursement
  • Out-of-network claims and provider litigation
  • Participating provider litigation
  • Payor contracts and value-based programs
  • Payment disputes
  • Provider agreements, reimbursement, and payment
  • Reimbursement audits
  • Review of billing submittals and coding practices
  • Take backs and offsets