AAP Pediatric Councils

The National AAP encourages chapter development of pediatric councils as forums to discuss pediatric issues with payers. Pediatric councils have the potential to facilitate better working relationships between pediatricians and local health insurance plans and to improve quality of care for children. Ideally, changes may lead to more appropriate coverage for pediatric services, as well as smooth and efficient health plan claims adjudication.

What is a Pediatric Council?

Structurally, a chapter pediatric council is a group of pediatricians, pediatric medical subspecialists, and pediatric surgical specialists formed to assist their chapter with issues pertaining to payer policies and payment. The primary goal is to build relationships and foster open dialogue with payers, and if possible, the state Medicaid authority. Pediatric councils are an effective strategy in the process of advocating for equitable access to care, high quality care, minimized administrative burden, and appropriate payment for services.

NOTE: A pediatric council is not a forum for joint contract negotiation, individual contract discussion or other fee-related concerns.

Through these relationships, these individuals meet regularly to discuss issues and opportunities that impact the ability of all children to receive recommended care and the ability of physicians to provide recommended care to children. Topics of discussion may include, but are not limited to, the following:

Benefits of Pediatric Councils

Chapters have reported this collaborative process has led to the following distinct beneficial outcomes:

• Enhanced communication with payers
• Helped identify key contacts with whom to work
• Led to payer policies that consider the unique needs of children
• Informed efforts about pediatric practice and delivery, and
• Assisted in resolving issues with payer policies and practices.

Many chapters currently have a pediatric council. For those chapters that do not we encourage chapter members who have an interest and knowledge of the payer world to join or start up a pediatric council. Reach out to your chapter or contact AAP staff for more information.

For pament or coding related questions, please contact the Coding & Payment Hotline.