Managed Care Contracting. 3.2.1. Manager shall act as GROUP’s exclusive agent in seeking and negotiating managed care contracts (“Contracts”). Manager is hereby authorized to negotiate, in its sole discretion, all terms of the Contracts. GROUP hereby appoints Manager for the term hereof as its true and lawful agent to perform all actions contemplated by this Section including, without limitation, the evaluation, negotiation, administration, renewal and execution of Contracts on GROUP’s behalf and binding GROUP to performance thereunder, provided that the Plan with whom each Contract is entered agrees to pay an amount for GROUP’s professional services thereunder equal to or greater than the minimum rate that GROUP shall specify to Manager. GROUP shall complete and execute the Power of Agency attached hereto as Exhibit “C.”
3.2.2. Manager shall also be responsible for general monitoring of GROUP compliance with the requirements, terms and conditions of Plan Contracts.
3.2.3. Manager shall notify and provide copies to GROUP of each Contract (together with all related materials received from the applicable Payor) that Manager executes as GROUP’s agent. GROUP shall comply with all terms of each Contract including, without limitation, the terms of all documents or instruments incorporated therein by reference and all documents or instruments related thereto that Manager executes or agrees to on GROUP’s behalf, as well as all applicable law. GROUP further agrees that an essential term of this Agreement is GROUP’s undertaking to provide cost-effective medical care consistent with accepted medical practices prevailing in the GROUP’s service area.
3.2.4. Nothing in this Agreement shall prevent Manager from entering into similar agreements with Plans on behalf of other independent practice associations, medical groups, physicians, health care professionals or entities comprised of physician or health care professionals.
3.2.5. GROUP acknowledges and agrees that (i) Manager shall in no way be responsible for payment of any sums payable to GROUP under any such Contract (whether by any Payor or otherwise), and (ii) Manager in no way guarantees or insures the payment to GROUP of any such amounts.
Managed Care Contracting. Except as otherwise provided in Section 9, below, Veracyte shall be responsible for all managed care contracting.
Managed Care Contracting. ProMedCo-Temple will be responsible for marketing, negotiation, and administering all managed care contracts, subject to the provisions of Section 2.2(j); provided, however, no contract or arrangement regarding the provision of clinical services shall be entered into without KDCP's consent.
Managed Care Contracting. From and after the date hereof and at the request of Buyers, Sellers shall use their commercially reasonable good faith efforts to assist Buyers in establishing relationships with managed care organizations, insurers and other third party payors that have agreements with Sellers and/or their Affiliates in which the Facilities participate.
Managed Care Contracting. (a) The Company shall review all proposed managed care contracts and provide recommendations to the Practice regarding whether the participation in such managed care contract is consistent with the Annual Budget. The Practice shall execute only such managed care contracts as may be consistent with the Annual Budget (unless otherwise approved by the Company) and shall (and shall cause the Professional Staff to) abide by the terms of any such contract. Notwithstanding the foregoing, no Party shall execute a managed care contract pertaining to Radiation Oncology Services to be provided at the Cancer Centers without the other Party’s prior written consent (which consent shall not be unreasonably withheld).
(b) The Practice shall ensure that: (i) each Physician participates (without interruption or suspension) in Medicare, Medicaid, TRICARE, workers’ compensation, other federal and state reimbursement programs, and the payment plan of any commercial insurer, health maintenance organization, preferred provider organization, or other health benefit plan or program with which the Practice may contract or affiliate from time to time and (ii) the Professional Staff complies with appropriate utilization control and review mechanisms and quality improvement policies implemented by the Company or by appropriate managed care programs, Third-Party Payors, governmental agencies and accreditation bodies, including without limitation, Joint Commission, ACR and ACCC.
Managed Care Contracting. As applicable, the parties agree to participate in and comply with the provisions of any participating provider, managed care and other third party payor contracts entered into by the parties.
Managed Care Contracting. (a) MANAGER shall be responsible for managed care contracting activities of IPA, including, without limitation, identifying, soliciting, reviewing, evaluating, negotiating and executing Payor Agreements (including prepaid capitation, exclusive provider and preferred provider agreements) in the name of IPA, and as directed by IPA, on behalf of IPA Physicians. In addition, MANAGER shall be responsible for negotiating agreements with a network of hospitals and ancillary service providers; tracking contract renewal dates for agreements with Payors and IPA Physicians and Providers; establishing and negotiating fee schedules for IPA Physicians and IPA Providers; and securing appropriate reinsurance coverage from Payors. IPA hereby expressly grants to MANAGER a power of attorney authorizing MANAGER to negotiate and execute such agreements on behalf of IPA; provided, however, the authority granted pursuant to such power of attorney shall be limited by the terms of Section (b) below. IPA shall obtain in its written agreements with IPA Providers authorizations for MANAGER to act as attorney-in-fact for such IPA Providers.
(b) MANAGER shall not execute or enter into a Payor Contract which is not in compliance with the IPA Executive Committee’s then current Contracting Guidelines without first submitting said agreement to the IPA Executive Committee for review and approval. A Payor Contract that is in compliance with the Contracting Guidelines may be executed by MANAGER, on behalf of IPA and IPA Providers, at MANAGER’s discretion and without the approval of the IPA Executive Committee, provided MANAGER shall have furnished IPA with a summary of the essential terms of such Payor Contract at least five (5) business days prior to its intended execution date. If IPA objects to MANAGER’s execution of the Plan Agreement, IPA shall so notify MANAGER prior to the expiration of the five (5) business day period and shall convene a meeting of the IPA Executive Committee. No later than five (5) business days after IPA’s notice to MANAGER, the IPA Executive Committee may direct MANAGER not to execute the Agreement or not to execute the Payor Contract until specified changes have been made to the Agreement and MANAGER shall comply with such direction. IPA shall be conclusively deemed to have granted approval to IPA to execute a Payor Contract if directions from the IPA Executive Committee are not received by MANAGER within ten (10) business days after IPA’s receipt of the summary o...
Managed Care Contracting. ProMedCo-SW will be responsible for marketing, negotiation, and administering all managed care contracts, subject to the provisions of Section 2.2(j); provided, however, no contract or arrangement regarding the provision of clinical services shall be entered into without NMC's consent.
Managed Care Contracting. With the approval of the majority of the members of the Clinic Committee that are designees of Metroplex, Metroplex shall participate with those payors that Texas Sub or Texas Sub's affiliates participate with and shall in any event accept Medicare and Medicaid patients. Metroplex shall permit Texas Sub to use Metroplex's name in seeking third-party payor contracts, and Texas Sub shall be permitted to identify the physicians. Through an overall Texas Sub managed care contracting strategy, Metroplex, other Texas Sub affiliated physicians and Texas Sub will develop proposals to payors. These proposals shall be developed in part utilizing criteria that will be developed by Metroplex and Texas Sub and other affiliated physicians. The criteria will require that Metroplex, Texas Sub and the other affiliated physicians provide services at competitive rates. The criteria will enable Texas Sub and Metroplex to compete with other providers of managed care, recognizing the need for both Metroplex and Texas Sub to increase the number of patients within managed care programs for which Metroplex provides services. The criteria are intended to enable all parties to act in a unified manner, consistent with all applicable legal requirements, and may include bundled billing, capitated contracts and the like. In the marketplace, Metroplex will identify itself as affiliated with Texas Sub. Metroplex will not permit any healthcare provider to use its name in payor contracting or marketing efforts without the prior written consent of Texas Sub, which consent will not unreasonably be withheld, except for any third party payor contractor. Further, except as specifically provided on Schedule 11 attached hereto, Metroplex will not obtain management services or payor contracting assistance or services from any party, or amend any agreement for the provision of the same, or participate in any provider network or affiliation other than from or through Texas Sub without the prior written consent of Texas Sub, which consent will not unreasonably be withheld. The parties shall exert particular effort to assure that the managed care and other integration initiatives of Texas Sub are successful, it being the mutual understanding of the parties that this Agreement is one among several physician integration initiatives of Texas Sub, and Metroplex shall act in a collaborative fashion in these other initiatives.
Managed Care Contracting. [*]. Such managed care contracting services shall be provided by UCH pursuant to the Support Agreement.
