Process of Termination. At least ninety (90) days prior to the effective date of termination of this Agreement, or the termination of Provider’s status as a Participating Provider, HPN or the respective Payer shall provide written explanation to Provider of the reasons for termination, except in the case of imminent harm to patient health, action against Provider’s license, certification or accreditation, or fraud, in which case termination may be immediate. On request and before the effective date of the termination of this Agreement, or the termination of a Provider’s status as a Participating Provider, but within a period not to exceed sixty (60) days, Provider shall be entitled to a review of HPN’s proposed termination by an advisory review panel, except in a case in which there is imminent harm to patient health or an action by a state licensing board or other accreditation or certification body or government agency, that effectively impairs Provider’s ability to operate in the State, or in a case of fraud or malfeasance. The advisory review panel shall be composed of Participating Providers appointed to serve on the standing quality assurance committee or utilization review committee of HPN or the respective Payer. The decision of the advisory review panel must be considered but is not binding. HPN or the respective Payer shall provide to Provider, on request, a copy of the recommendation of the advisory review panel and HPN’s or the respective Payer’s determination. Provider shall be entitled to an expedited review process by HPN or Payer on request of Provider. Except for termination based on imminent harm to Members, HPN or Payer shall notify Members of the termination of Provider’s status as a Participating Provider at least thirty (30) days prior to the effective date of the termination or the advisory review panel makes a formal recommendation. Provider agrees to assist HPN and Payer in providing such written notice as well as a description of alternative care.
Appears in 2 contracts
Samples: Ancillary Participation Agreement, Ancillary Participation Agreement (Certified Diabetic Services Inc)
Process of Termination. At least ninety (90) days prior to the effective date of termination of this Agreement, or the termination of Provider’s status as a Participating Provider, HPN or the respective Payer SelectCare shall provide written explanation to Provider of the reasons for termination, except in the case of imminent harm to patient health, action against Provider’s license, certification or accreditation, or fraud, in which case termination may be immediate. On request and before the effective date of the termination of this Agreement, or the termination of a Provider’s status as a Participating Provider, but within a period not to exceed sixty (60) days, Provider shall be entitled to a review of HPNSelectCare’s proposed termination by an advisory review panel, except in a case in which there is imminent harm to patient health or an action by a state licensing board or other accreditation or certification body or government agency, that effectively impairs Provider’s ability to operate in the State, or in a case of fraud or malfeasance. The advisory review panel shall be composed of Participating Providers appointed to serve on the standing quality assurance committee or utilization review committee of HPN or the respective PayerSelectCare. The decision of the advisory review panel must be considered but is not binding. HPN or the respective Payer SelectCare shall provide to Provider, on request, a copy of the recommendation of the advisory review panel and HPN’s or the respective PayerSelectCare’s determination. Provider shall be entitled to an expedited review process by HPN or Payer SelectCare on request of Provider. Except for termination based on imminent harm to Members, HPN or Payer SelectCare shall notify Members of the termination of Provider’s status as a Participating Provider at least thirty (30) days prior to the effective date of the termination or the advisory review panel makes a formal recommendation. Provider agrees to assist HPN and Payer SelectCare in providing such written notice as well as a description of alternative care.
Appears in 2 contracts
Samples: Ancillary Participation Agreement, Ancillary Participation Agreement (Certified Diabetic Services Inc)