Becoming a panel clinic is an important milestone for any healthcare provider.
It signifies meeting rigorous quality standards and being selected by an insurance company or healthcare system to serve its members.
However, the appointment letter formalizing this relationship is more than just paperwork – it’s a crucial document outlining the roles, responsibilities, and terms of the partnership.
Getting the appointment letter right is key to setting clear expectations and building a strong foundation for collaboration.
Read on for 15 sample letters you can adapt for your own practice’s panel clinic appointment.
Sample Letters of Appointment as Panel Clinic
Here are the sample appointment letters:
Letter 1 – Appointment as In-Network Provider for ABC Health Plan
Dear Dr. Johnson,
We are pleased to inform you that ABC Health Plan has selected your practice, Main Street Family Medicine, to join our network as an in-network provider effective January 1, 20XX. Your participation is contingent upon meeting the credentialing requirements outlined in the attached Participating Provider Agreement.
As an in-network provider, you agree to provide medically necessary services to our members according to the fee schedule in Exhibit A. Claims should be submitted electronically within 90 days of the date of service. Payments will be issued within 30 days of receipt of clean claims.
Please review and sign the attached agreement and return it to us by December 1, 20XX. We look forward to partnering with you to provide high-quality, cost-effective care to our members in the Pleasantville community.
Sincerely,
Jane Smith
Director, Provider Network Management
ABC Health Plan
Letter 2 – Appointment to Preferred Provider Network for State Employees Health Plan
Dear Dr. Patel,
Congratulations! Based on your reputation for clinical excellence and patient satisfaction, the State Employees Health Plan has selected Lakeview Pediatrics to join our Preferred Provider Network effective February 1, 20XX.
As a preferred provider, you will be highlighted in our provider directory and receive expedited claims processing. In return, you agree to accept the reimbursement rates specified in the enclosed Provider Services Manual and comply with our utilization management and quality improvement protocols.
To accept this appointment, please complete the credentialing application in the Provider Portal by January 15, 20XX. Our Provider Relations team is available to assist you throughout the onboarding process.
We value your partnership in serving our members and look forward to a mutually beneficial relationship.
Best regards,
John Brown
Contracts Manager
State Employees Health Plan
Letter 3 – Invitation to Join Preferred Physician Network for Acme Company
Dear Dr. Garcia,
As a leading employer in the Mountain View area, Acme Company is committed to providing our employees with access to top-notch healthcare. Based on your outstanding credentials and alignment with our core values, we would like to invite Montclair Medical Center to join the Acme Preferred Physician Network.
The Preferred Physician Network is a select group of providers who work closely with our benefits team to deliver coordinated, patient-centered care to our employees and their families. Benefits of participation include:
- Exclusive referrals from our employee population of 5,000+ members
- 10% bonus on fee schedule rates
- Dedicated Provider Relations Representative
- Opportunities to provide onsite health education workshops
If you wish to accept this invitation, return the signed Network Participation Agreement by March 1, 20XX. We hope you will join us in promoting the health and well-being of the Acme community.
Warm regards,
Sarah Johnson
Benefits Manager Acme Company
Letter 4 – Welcome to the Multicultural Health Network
Dear Dr. Hernandez,
On behalf of the Multicultural Health Network (MHN), I am delighted to welcome South City Community Health Center as our newest member clinic, effective April 1, 20XX. MHN is a coalition of providers dedicated to reducing health disparities and improving outcomes in diverse communities.
As an MHN member, your clinic will receive:
- Access to cultural competency training and resources
- Eligibility to apply for community health grants
- Promotion in MHN’s Community Health Directory
- Invitations to quarterly best practice sharing sessions
To maintain your membership, your clinic agrees to:
- Participate in the MHN quality improvement data registry
- Send at least one representative to the annual MHN conference
- Disseminate MHN patient education materials in your clinic
We commend your commitment to advancing health equity and look forward to collaborating with you to build healthier communities.
In partnership,
Michael Lee
Executive Director
Multicultural Health Network
Letter 5 – Appointment as Workers’ Compensation Authorized Provider
Dear Dr. Gupta,
We are pleased to appoint Rose City Orthopedics as an authorized provider for the Statewide Workers’ Compensation Fund effective May 1, 20XX. Your practice was selected based on your expertise in occupational medicine and track record of successful return-to-work outcomes.
As an authorized provider, you agree to:
- Comply with Workers’ Compensation treatment guidelines and billing protocols
- Submit required documentation, including initial evaluations, progress reports, and final evaluations
- Participate in case conferences and disability management planning as needed
In return, you will receive:
- Expedited authorization process for procedures
- Invitation to the annual Workers’ Compensation Educational Symposium
- Access to Nurse Case Managers for complex cases
Please complete the training module in the Provider Portal by April 15, 20XX. We appreciate your partnership in supporting the health and productivity of our state’s workforce.
Sincerely,
Laura Thompson
Provider Relations Coordinator
Statewide Workers’ Compensation Fund
Letter 6
Dear Dr. Chen,
I am writing to inform you that Downtown Urgent Care has been selected to join the SmartER Network, a group of preferred urgent care centers that provide after-hours care to members of Municipal Employees Health Trust. Your appointment is effective June 1, 20XX.
As a SmartER provider, you agree to provide services during the hours of 6 pm-6 am Monday through Friday and 24 hours on weekends and holidays. Members will be directed to SmartER locations via our 24/7 nurse advice line. Please direct any questions regarding member eligibility or benefits to our customer service team.
Reimbursement will be at the rates outlined in the SmartER Provider Manual. You will also have the opportunity to earn quality bonuses by meeting targets for patient satisfaction, wait times, and 7-day PCP follow-up.
To onboard as a SmartER provider, our Contracting team will reach out to complete the credentialing and enrollment process. We look forward to working with you to improve after-hours access to care.
Regards,
Mark Davis
Director of Provider
Contracting Municipal Employees Health Trust
Letter 7
Dear Dr. Pham,
We are delighted to appoint Lakeshore Behavioral Health as a specialty provider in the Tri-County Mental Health Network effective July 1, 20XX. The Network was established to increase access to quality behavioral health services for Medicaid enrollees in Tri-County.
Your practice was selected for its multidisciplinary expertise in outpatient mental health and substance use treatment for children and adolescents. As a Network provider, you agree to:
- Accept all referred Tri-County Medicaid patients
- Provide initial evaluations within 10 business days of referral
- Communicate treatment plans to referring PCPs
- Report access and quality measures to the Network quarterly
The Tri-County Behavioral Health Department provides care coordination and other supportive services to Network providers. To get started, complete the Specialty Provider Applications located at www.tricountymentalhealth.gov/providers.
Our Medicaid members face many challenges in accessing timely, appropriate behavioral health care. We appreciate your partnership in ensuring they receive the services they need.
Sincerely,
Dr. Elizabeth Nguyen
Medical Director
Tri-County Mental Health Network
Letter 8
Dear Dr. Jackson,
We are excited to welcome Greenville Pediatrics to the HealthyKids HMO as a Tier 1 Preferred Pediatric Provider effective August 1, 20XX. HealthyKids serves children in low-income families across the state.
Tier 1 providers are selected for their commitment to medical home principles, including care coordination, extended hours, use of evidence-based protocols, and integration of behavioral health. In return for your enhanced access and quality, you will receive a 15% increase over standard fee-for-service rates with opportunities for shared savings.
To maintain Tier 1 status, your practice must:
- Have 95% of patients up-to-date on immunizations and well-child visits
- Maintain NCQA Patient-Centered Medical Home recognition
- Achieve minimum thresholds on HEDIS measures related to pediatric asthma, ADHD, and adolescent depression screening
By joining the HealthyKids network, you are helping to build a brighter, healthier future for our most vulnerable children. We are honored to partner with you in this vital mission.
Best,
Jennifer Wilson
Provider Network Manager
HealthyKids HMO
Letter 9
Dear Dr. Singh,
On behalf of Valley Health System, I am pleased to appoint ABC Cardiology as a preferred provider for cardiovascular services effective September 1, 20XX. This appointment reflects your practice’s leadership in providing comprehensive, coordinated heart care.
As a preferred provider, ABC Cardiology will be the first choice for cardiology referrals from Valley’s extensive primary care network. You will also have priority access to Valley’s diagnostic imaging and interventional facilities. In return, you agree to clinical integration protocols as outlined in the Valley Cardiovascular Care Model, including:
- Collaborative development of evidence-based care pathways
- Participation in interdisciplinary heart care case conferences
- Timely communication of care plans to referring providers
- Regular reporting of process and outcomes metrics
Valley is committed to providing world-class heart care to our community in partnership with leading cardiovascular groups like ABC Cardiology. Please complete the Clinical Integration readiness assessment to begin the onboarding process.
I look forward to working together to keep hearts healthy across the Valley region.
Regards,
Dr. Rahim Patel
Chief of Cardiovascular Services
Valley Health System
Letter 10
Dear Dr. Nguyen,
We are delighted to appoint Lakeside Women’s Health as an affiliate provider for the Healthy Moms obstetrical network effective October 1, 20XX. Healthy Moms is a Medicaid ACO dedicated to improving maternal and infant outcomes.
As an affiliate provider, you agree to follow Healthy Moms’ evidence-based prenatal and postpartum care guidelines, including mental health and social needs screening. You will have access to network resources including care coordination, health education, and social services. Reimbursement will be on a case-rate basis adjusted for clinical and social risk factors.
To maintain affiliate status, your practice must meet benchmarks on key perinatal metrics such as timeliness of prenatal care, C-section rates, and postpartum visit attendance. You will receive quarterly performance reports to support continuous quality improvement.
We believe that every mother and baby deserves the best possible start. Your partnership in providing comprehensive, culturally appropriate maternity care to Medicaid beneficiaries is deeply appreciated.
In collaboration,
Cynthia Brown
Director of Provider Engagement
Healthy Moms Medicaid ACO
Letter 11
Dear Dr. Torres,
Pacific Health Plan is launching an innovative oncology medical home program, and we would be honored to have Highlands Cancer Center participate as a founding provider. Your appointment would be effective November 1, 20XX.
The oncology medical home model is designed to provide comprehensive, coordinated care for cancer patients while ensuring appropriate stewardship of chemotherapy and supportive care medications. As a participating provider, Highlands would commit to:
- Providing team-based care with 24/7 patient access
- Using standardized treatment pathways based on national guidelines
- Proactive monitoring and management of treatment side effects
- Advanced care planning and palliative care integration
- Financial counseling and navigation services
In return, Highlands would receive enhanced reimbursement, including monthly care management fees, performance incentives, and value-based contracting options for chemotherapy and supportive care drugs.
We believe the oncology medical home offers a promising model for improving the patient experience, clinical outcomes, and affordability of cancer care. We would be thrilled to partner with Highlands in bringing this innovative model to the Pacific region.
Please let me know if you would like to discuss further. I look forward to the possibility of collaboration.
Best regards,
Lisa Kim
Director of Specialty Care
Transformation Pacific Health Plan
Letter 12
Dear Dr. Robinson,
I am writing to inform you that Healthpoint Rehabilitation Center has been selected as a preferred provider for the City Employees Occupational Health Program effective December 1, 20XX.
As a preferred provider, you agree to provide expedited appointments and work closely with the City’s HR department and the employee’s supervisor to support safe and timely return to work. This includes:
- Same-day appointment access for work-related injuries
- Detailed functional job descriptions to guide return-to-work planning
- Weekly progress reports to HR and employee’s supervisor
- Ergonomic evaluations and work conditioning programs as needed
In return, Healthpoint will receive a 20% enhanced reimbursement rate for Occupational Health services and referrals for other City employees needing rehabilitation services, such as those recovering from strokes or joint replacements.
Helping our dedicated City employees get back to work after injury or illness is an important public service. We value your partnership in ensuring they receive timely, high-quality rehabilitation services.
To get started, please complete the credentialing forms at cityhealth.org/providers and register for our provider portal training.
I look forward to working together to keep our City workforce healthy and productive.
Sincerely,
Karen Nguyen
Occupational Health Program Manager
City Human Resources Department
Letter 13
Dear Dr. Lee,
Congratulations! Riverview Home Health Agency has been selected as a preferred provider for the Community Hospital Accountable Care Organization (ACO) effective January 1, 20XX.
As a preferred home health provider, Riverview will work closely with the ACO’s Care Transitions team to provide seamless post-acute care for patients discharged from Community Hospital. Key expectations include:
- Initiating services within 24 hours of referral
- Frequent communication with PCP and hospitalist about patient’s progress
- Use of telehealth for timely assessment of red flags
- Coordination of home safety evaluation and medication reconciliation
- Submission of OASIS data and other required quality metrics
In return, Riverview will receive a bonus of up to 10% of total visit reimbursement for helping the ACO to achieve its goals of reducing readmissions, ER visits, and total cost of care for attributed patients.
Effective care transitions are vital to the success of our ACO in improving outcomes and lowering costs. We are confident that Riverview’s expertise and commitment to collaboration will help keep our patients safe and well-supported as they recover at home.
Please return the signed Preferred Provider Agreement by December 15th. Our Care Transitions team looks forward to an outstanding partnership.
Regards,
James Garcia
Post-Acute Care Coordinator
Community Hospital ACO
Letter 14
Dear Dr. Gupta,
We are delighted to appoint Bright Smiles Dental as a network provider for the HealthyKids LowIncome Dental Plan effective February 1, 20XX. HealthyKids aims to improve access to quality dental care for children in underserved communities.
As a HealthyKids provider, your practice will receive enhanced reimbursement for preventive and restorative services according to the enclosed fee schedule. In return, you agree to:
- See HealthyKids patients within 30 days for routine care and 48 hours for urgent needs
- Provide all Basic and Major Services covered by HealthyKids
- Not balance bill HealthyKids patients for covered services
- Submit claims and encounter data electronically
Participate in HealthyKids’ Cavity-Free Kids program to promote oral health
We look forward to working with you to ensure every child has a healthy smile. To get started, complete the Participating Provider Application at healthykids.org/providers.
Sincerely,
Anita Patel
Dental Director
HealthyKids LowIncome Dental Plan
Letter 15
Dear Dr. Wang,
On behalf of the Senior Health Alliance, I am pleased to appoint Golden Years Geriatrics as a preferred provider for our Medicare Advantage Special Needs Plan effective March 1, 20XX.
As a preferred provider, Golden Years agrees to provide comprehensive, team-based care for our frail elderly members, including:
- Geriatric assessment and care planning
- 24/7 access and same-day urgent visits
- Home visits for homebound patients
- Coordination with Alliance care managers and community services
- Completion of risk adjustment and HEDIS quality reporting
In return, Golden Years will receive capitated payments adjusted for each patient’s risk score, with opportunities for quality bonuses. The Alliance will also provide practice transformation support, data analytics, and referrals from our community outreach teams.
Improving care for vulnerable seniors is a shared mission of the Alliance and Golden Years. We are excited to partner in providing the highest-quality, most compassionate care for older adults in our community.
To begin the contracting process, please contact our Provider Relations Manager at (555) 123-4567 or provider.relations@seniorhealthalliance.org.
I look forward to an impactful partnership.
Best regards,
Elizabeth Johnson
Executive Director
Senior Health Alliance
Wrapping Up: The Importance of Appointment Letters for Panel Clinics
These 15 sample letters demonstrate the diverse range of appointment scenarios for panel clinics, from primary care to specialty care, commercial insurance to Medicaid, ACOs to occupational health.
While the specifics vary, the letters share common elements:
- Specifying the effective date and terms of the appointment
- Outlining mutual expectations and accountability
- Providing practical next steps to launch the partnership
- Conveying enthusiasm for collaboration to improve patient care
A thoughtful, thorough appointment letter sets a positive tone for the partnership between a payer or health system and a panel clinic.
It also serves as an important reference document to guide the relationship.
When crafting your appointment letters, be sure to tailor the content to your organization’s unique programs and priorities.
Strive for clarity, completeness, and an authentic tone that embodies your partnership approach.
Appointment as a panel clinic marks an exciting new chapter for a practice.
By starting on the right foot with a well-crafted appointment letter, you lay the foundation for a productive, enduring collaboration to enhance care in your community.