Participating Provider Agreement Template

Posted on: December 14th, 2020 by localoneway No Comments

5.03 Full Agreement and Séverability: This agreement, along with all the annexes and exhibits that will be included in this Agreement and with all the duly amended amendments to that agreement, constitutes the entire agreement of the parties and replaces all previous agreements and agreements reached by the parties with respect to the purpose of this agreement. The provisions of this agreement are independent and separate. If a provision is found to be invalid or unenforceable, it will not render another provision invalid or unenforceable, unless that provision substantially alters the responsibilities of the parties under this agreement. 2.10 Use management and quality improvement requirements: managed car plans will adopt standards and requirements for usage management and quality improvement, which aim to promote the provision of quality and cost-effective healthcare to its members. When rendering covered services for members, the provider is committed to meeting the requirements of managing the use and improving the quality of the health benefit program, in which each member is registered. These requirements may include, among other things, pre-authorization or pre-certification prior to issuance or obtaining referrals, participation in case management, and coordination of care with other providers. Such usage management and quality improvement requirements may include office audits of medical records, periodic inspections and investigations, case-specific audits and other simultaneous and retrospective audits by SelectHealth and Affiliated Managed Care Plans. Managed Care Plans may also adopt physician-recognized guidelines for clinical practice and require compliance with such guidelines, unless the best of the patient`s interest dictates something else. Managed care plans provide the provider with information about these requirements.

The provider is committed to meeting the standards and requirements for managing and improving the quality of managed care plans and to cooperating with managed care plans to improve the performance of managed care plans. 4.09 Group Suppliers: In the event that the supplier is a member or practice of a group of other suppliers that also enter into contracts with SelectHealth, the requirements of this contract, including, but not limited, termination clauses, apply to each supplier separately and not to the group as a whole. 1.12 Provider: The health care provider who subserance with SelectHealth under this agreement. A participating provider agreement is a contract between a health care provider and a benefit plan for workers. The agreement provides that the provider accepts payments under the patient services plan covered by this plan. In return, the plan administrator will encourage plan participants to use preferred providers for their health needs. Because many participating providers are small independent medical practices and independent clinics, the agreement allows benefit plan managers and health care providers to control the rising health costs. 4.08 Termination of supplier participation in a related managed care plan: Related managed care plans may terminate any supplier that has entered into a contract provider contract contract for its respective members through SelectHealth, for one of the reasons outlined in Part 4. Such layoffs do not automatically terminate the supplier to other managed care plans. However, SelectHealth`s termination terminates participation in this contract with all related management plans. 1.07 Medically necessary: unless otherwise stated in the applicable health care program, benefits are medically necessary if they are necessary and in accordance with the generally accepted principles of good medical practice and professionally recognized standards for the diagnosis, care and treatment of a disease, illness, illness or injury covered as part of a (solved) health care program.

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