Common use of Other Network Provider Requirements Clause in Contracts

Other Network Provider Requirements. (A) The Contractor shall ensure that its Network Providers abide by the requirements of Section 1877(E)(3)(B) of the Social Security Act prohibiting the Contractor Providers from making payments directly or indirectly to a physician or other provider as an inducement to reduce or limit Medically Necessary services provided to Enrollees. (B) The Contractor shall ensure that Network Providers and staff are knowledgeable about methods to detect domestic violence, about mandatory reporting laws when domestic violence is suspected, and about resources in the community to which patients can be referred. (C) All of the Contractor’s Network Providers shall be aware of the Contractor’s Quality Assessment and Performance Improvement Plan (QAPIP) and activities. All of the Contractor’s agreements with Network Providers shall include a requirement securing cooperation with the Contractor’s QAPIP and activities and shall allow the Contractor access to the medical records of Enrollees being treated by Network Providers. (D) All physicians who provide services under this Contract shall have a unique identifier in accordance with the system established under Section 1173(b) of the Social Security Act and in accordance with the Health Insurance Portability and Accountability Act. (E) The Contractor shall ensure its Network Providers are either enrolled with the Department as a Fee-For-Service provider or are enrolled with the Department as a “limited enrollment provider.”

Other Network Provider Requirements. (A) The Contractor shall ensure that its Network Providers abide by the requirements of Section 1877(E)(3)(B) of the Social Security Act prohibiting the Contractor Providers from making payments directly or indirectly to a physician or other provider as an inducement to reduce or limit Medically Necessary services provided to Enrollees. (B) The Contractor shall ensure that Network Providers and staff are knowledgeable about methods to detect domestic violence, about mandatory reporting laws when domestic violence is suspected, and about resources in the community to which patients can be referred. (C) All of the Contractor’s Network Providers shall be aware of the Contractor’s Quality Assessment and Performance Improvement Plan (QAPIP) and activities. All of the Contractor’s agreements with Network Providers shall include a requirement securing cooperation with the Contractor’s QAPIP and activities and shall allow the Contractor access to the medical records of Enrollees being treated by Network Providers. (D) All physicians who provide services under this Contract shall have a unique identifier in accordance with the system established under Section 1173(b) of the Social Security Act and in accordance with the Health Insurance Portability and Accountability Act. (E) The By January 1, 2018, the Contractor shall ensure all of its Network Providers are either enrolled with the Department as a Fee-For-Service provider or are enrolled with the Department as a “limited enrollment provider.” (F) The Contractor shall ensure that its Providers who prescribe medication are enrolled with the Department otherwise the Providers’ pharmacy claims will not be paid.