Common use of HOOSIER HEALTHWISE SCOPE OF WORK Clause in Contracts

HOOSIER HEALTHWISE SCOPE OF WORK.  Include a termination clause stipulating that the Contractor shall terminate its contractual relationship with the provider as soon as the Contractor has knowledge that the provider’s license or IHCP provider agreement has terminated.  Terminate the provider’s agreement to serve the Contractor’s Hoosier Healthwise members at the end of the Contract with the State.  Monitor providers and apply corrective actions for those who are out of compliance with FSSA’s or the Contractor’s standards.  Obligate the terminating provider to submit all encounter claims for services rendered to the Contractor’s members while serving as the Contractor’s network provider and provide or reference the Contractor’s technical specifications for the submission of such encounter data.  Not obligate the provider to participate under exclusivity agreements that prohibit the provider from contracting with other state contractors.  Provide the PMP with the option to terminate the agreement without cause with advance notice to the Contractor. Said advance notice shall not have to be more that ninety (90) calendar days.  Provide a copy of a member’s medical record at no charge upon reasonable request by the member, and facilitate the transfer of the member’s medical record to another provider at the member’s request.  Require each provider to agree that it shall not seek payment from the State for any service rendered to a Hoosier Healthwise member under the agreement.  For behavioral health providers, require that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment must be provided within seven (7) calendar days from the date of the member’s discharge.  Require each provider to agree to use best commercial efforts to collect required copayments for services rendered Package C members. The Contractor shall have written policies and procedures for registering and responding to claims disputes for out-of-network providers, in accordance with the claims dispute resolution process for non-contracted providers outlined in 405 IAC 1-1.6-1.

HOOSIER HEALTHWISE SCOPE OF WORK.  ▪ Include a termination clause stipulating that the Contractor shall terminate its contractual relationship with the provider as soon as the Contractor has knowledge that the provider’s license or IHCP provider agreement has terminated.  ▪ Terminate the provider’s agreement to serve the Contractor’s Hoosier Healthwise members at the end of the Contract with the State.  ▪ Monitor providers and apply corrective actions for those who are out of compliance with FSSA’s or the Contractor’s standards.  ▪ Obligate the terminating provider to submit all encounter claims for services rendered to the Contractor’s members while serving as the Contractor’s network provider and provide or reference the Contractor’s technical specifications for the submission of such encounter data.  ▪ Not obligate the provider to participate under exclusivity agreements that prohibit the provider from contracting with other state contractors.  ▪ Provide the PMP with the option to terminate the agreement without cause with advance notice to the Contractor. Said advance notice shall not have to be more that ninety (90) calendar days.  ▪ Provide a copy of a member’s medical record at no charge upon reasonable request by the member, and facilitate the transfer of the member’s medical record to another provider at the member’s request.  ▪ Require each provider to agree that it shall not seek payment from the State for any service rendered to a Hoosier Healthwise member under the agreement.  ▪ For behavioral health providers, require that members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge. This treatment must be provided within seven (7) calendar days from the date of the member’s discharge.  ▪ Require each provider to agree to use best commercial efforts to collect required copayments for services rendered Package C members. The Contractor shall have written policies and procedures for registering and responding to claims disputes for out-of-network providers, in accordance with the claims dispute resolution process for non-contracted providers outlined in 405 IAC 1-1.6-1.