IPAs — Independent Practice Associations
A legal entity organized and owned by a network of independent physician practices that contracts collectively with health plans and payers. Physicians retain independent practice ownership but negotiate collectively for reimbursement rates, share risk arrangements, and coordinate care delivery.
8
Primary Modules
6
Key API Integrations
6
Regulatory Requirements
Primary Portal Modules
Providers Claims Risk Pools Financial Auth Analytics Care Coordination Compliance
Organizational Relationships
▲ Vertical — Reports To (Upward)
- MCOs/Health Plans (contractual accountability for delegated functions)
- State regulators (Knox-Keene licensure in CA)
▼ Vertical — Oversees (Downward)
- Member physician practices
- Ancillary providers
- Sub-specialist networks
▶ Horizontal — Collaborates With (Peer)
- PHOs (shared provider networks)
- MSOs (administrative services)
- ACOs (overlapping quality/value programs)
- Hospitals (inpatient services)
- TPAs (claims processing)
- Labs and imaging centers
- Pharmacy benefit managers
Key API Integrations
X12 270/271 EligibilityX12 837/835 ClaimsFHIR Practitioner/PractitionerRoleQRDA Quality ReportingX12 278 Prior AuthorizationCAQH ProView Credentialing
Regulatory Requirements
- State Department of Managed Health Care
- NCQA accreditation for delegated functions
- CMS compliance for MA delegation
- HIPAA Privacy and Security
- Anti-Kickback Statute and Stark Law
- FTC/DOJ antitrust scrutiny