CHIP Provider Network Clause Samples
The CHIP Provider Network clause defines the group of healthcare providers, such as doctors, hospitals, and clinics, that participate in the Children's Health Insurance Program (CHIP) and are authorized to deliver covered services to enrolled children. This clause typically outlines the criteria for provider participation, the process for joining or leaving the network, and the obligations providers must meet to remain in good standing. By clearly establishing which providers are included in the network, the clause ensures that CHIP beneficiaries have access to approved healthcare services and helps manage costs and quality of care within the program.
CHIP Provider Network. In each Service Area, the HMO must seek to obtain the participation in its Provider Network of CHIP Significant Traditional Providers (STPs), defined by HHSC as PCP Providers currently serving the CHIP population and DSH hospitals. The Procurement Library includes CHIP STPs by Service Area. The HMO must give STPs the opportunity to participate in its Network if the STPs:
CHIP Provider Network. In each Service Area, the HMO must seek to obtain the participation in its Provider Network of CHIP Significant Traditional Providers (STPs), defined by HHSC as PCP Providers currently serving the CHIP population and DSH hospitals. The Procurement Library includes CHIP STPs by Service Area. The HMO must give STPs the opportunity to participate in its Network if the STPs:
1. Agree to accept the HMO’s Provider reimbursement rate for the provider type; and
2. Meet the standard credentialing requirements of the HMO, provided that lack of board certification or accreditation by the Joint Commission on Accreditation of Health Care Organizations (JCAHO) is not the sole grounds for exclusion from the Provider Network.