Provider Agreements. The Contractor must have a process in place to review and authorize all network provider contracts. The Contractor must submit a model or sample contract of each type of provider agreement to OMPP for review and approval at least sixty (60) calendar days prior to the Contractor’s intended use. The Contractor must notify OMPP of any changes to the sample contracts within three (3) weeks of the Contract award date. To allow sufficient processing time for the enrollment of the PMP and ensure an effective date of January 1, 2017, the Contractor shall submit the completed PMP enrollment request to the State fiscal agent through the WebInterchange-Provider Healthcare Portal by December 1, 2016. The Contractor shall include in all of its provider agreements provisions to ensure continuation of benefits. The Contractor shall identify and incorporate the applicable terms of its Contract with the State and any incorporated documents. Under the terms of the provider services agreement, the provider shall agree that the applicable terms and conditions set out in the Contract, any incorporated documents, and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to members. The requirement set forth in Section 2.7 that subcontractors indemnify and hold harmless the State of Indiana do not extend to the contractual obligations and agreements between the Contractor and health care providers or other ancillary medical providers that have contracted with the Contractor. In addition to the applicable requirements for subcontracts in Section 2.7, the provider agreements shall meet the following requirements: Describe a written provider claim dispute resolution process. Require each provider to maintain a current IHCP provider agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board. Require each provider to submit all claims that do not involve a third party payer for services rendered to the Contractor’s members within ninety (90) calendar days or less from the date of service. The Contractor shall waive the timely filing requirement in the case of claims for members with retroactive coverage, such as presumptively eligible pregnant women and newborns. Require each provider to utilize the Indiana Health Coverage Program Prior Authorization Request Form available on the Indiana Medicaid website for s...
Provider Agreements. The Practice shall not enter into contractual arrangements with third parties for the Practice's provision of Professional Eye Care Services which are inconsistent with guidelines established by the Local Advisory Council or any capitated fee arrangement without the prior approval of the Practice Advisory Council. Subject to the foregoing provision, the Practice shall have the final authority with regard to all of such contractual arrangements.
Provider Agreements. The Contractor must have a process in place to review and authorize all network provider agreements. The Contractor must submit a model or sample contract of each type of provider agreement to FSSA for review and approval at least sixty (60) calendar days prior to the Contractor’s intended use. Sample contracts should also be submitted by Respondents. The Contractor must notify FSSA of any changes to the sample contracts provided with the RFP response within three (3) weeks of the Contract award date. The Contractor must include in all of its provider agreements provisions to ensure continuation of benefits. The Contractor must identify and incorporate the applicable terms of the Contract with the State. Under the terms of the provider agreement, the provider must agree that the applicable terms and conditions set out in the Contract and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to members. The requirement set forth in Section 2.3 that subcontracts indemnify and hold harmless the State of Indiana does not extend to the contractual obligations and agreements between the Contractor and health care providers or other ancillary medical providers that have contracted with the Contractor. In addition to the applicable requirements for subcontracts in Section 2.3, the provider agreements must meet the following requirements: Describe a written provider claim dispute resolution process. Require each provider to maintain a current IHCP provider agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board. Require each provider to submit all claims that do not involve a third party payer for services rendered to the Contractor’s members within ninety (90) calendar days or less from the date of service. Include a termination clause stipulating that the Contractor must 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 Care Connect 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 th...
Provider Agreements. Contractor must have written agreements with a sufficient number of providers to ensure Member access to all Medically Necessary Services covered by CHIP. Contracts with all Behavioral Health providers must have provisions that all Members receiving inpatient psychiatric services are scheduled for outpatient follow-up and/or continuing treatment prior to discharge from the inpatient psychiatric hospital. Contractor’s provider agreements must include at least the following provisions:
1. A requirement that Contractor must not exclude or terminate a provider from participation in Contractor’s Provider Network due to the fact that the provider has a practice that includes a substantial number of Members with expensive medical conditions.
2. A requirement to ensure that Members are entitled to the full range of their health care providers' opinions and counsel about the availability of Medically Necessary Services under the provisions of this Contract. Any contractual provisions, including gag clauses or rules, that restricts a health care provider's ability to advise Members about medically necessary treatment options violate Federal law and regulations.
3. A requirement that Contractor cannot prohibit or restrict a provider acting within the lawful scope of practice from discussing Medically Necessary care and advising or advocating appropriate medical care with or on behalf of a Member including; information regarding the nature of treatment options; risks of treatment; alternative treatments; or the availability of alternative therapies, consultation or tests that may be self-administered.
4. A requirement that Contractor cannot prohibit or restrict a provider acting within the lawful scope of practice from providing information the Member needs in order to decide among all relevant treatment options and the risks, benefits, and consequences of treatment or non-treatment.
5. A requirement that Contractor cannot terminate a contract or employment with a provider for filing a Grievance or Appeal on a Member’s behalf.
6. A requirement securing cooperation with the QM and UM program standards outlined in Section 9, Quality Management, of this Contract.
7. A requirement that PCPs comply with requirements of Section 7.C, PCP Responsibilities, of this Contract.
8. A requirement that Contractor include in all capitated provider agreements a clause which requires that should the provider terminate its agreement with Contractor, for any reason, the provider will p...
Provider Agreements. The CHC-MCO must have written Provider Agreements with a sufficient number of Providers to provide Participant access to all Covered Services as set forth in Exhibit BB Provider Network Composition/Service Access. The requirements for these Provider Agreements are set forth in Exhibit DD, CHC-MCO Provider Agreements.
Provider Agreements. Contractor shall include in its Network Provider agreements, a provision requiring as a condition of receiving payment, that the Provider comply with section 5.35 of this Contract.
Provider Agreements. The Facility has current provider agreements under Titles XVIII and XIX of the Social Security Act.
Provider Agreements. The Contractor shall not include covenant-not-to-compete requirements in its provider agreements. Specifically, the Contractor shall not contract with a provider and require that the provider not provide services for any other AHCCCS Contractor. In addition, the Contractor shall not enter into subcontracts that contain compensation terms that discourage providers from serving any specific eligibility category.
Provider Agreements. Contractor must have a process in place to review and authorize all Participating Provider contracts. The Participating Provider contracts must not be in conflict with any aspect of the DVHA General Provider Agreement. DVHA reserves the right to review and approve Contractor network contracts on an annual basis to ensure compliance with this Contract prior to them being sent to Participating Providers. Participating Provider contracts will contain requirements to maintain active Medicaid participation, to report any events that may impact that participation, and to immediately report any termination from Medicaid. Participating Provider agreements will also require both the Participating Providers and Contractor to comply with all applicable federal, state and local laws and regulations. Contractor shall include in all its provider agreements provisions to ensure continuation of benefits as required by law. Contractor shall identify and incorporate the applicable terms of this Contract with DVHA into its provider agreements. Under the terms of the Participating Provider contract, the provider shall agree that the applicable terms and conditions set out in the Participating Provider contract, any incorporated documents, and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to Members. The Participating Provider contracts shall meet the following requirements:
a. Describe the provider claim dispute resolution process;
b. Require each provider to maintain a current Vermont Medicaid General Provider Agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board;
c. Require providers to adhere to DVHA timely filing requirements for claims submissions;
d. Include a termination clause stipulating that Contractor shall terminate its contractual relationship with the provider as soon as Contractor has knowledge that the provider’s license or Vermont Medicaid General Provider Agreement has terminated;
e. Obligate the terminating provider to submit all claims or encounters for services rendered to Contractor’s Members to Fiscal Agent while serving as Contractor’s Participating Provider;
f. Not obligate the provider to participate under exclusivity agreements that prohibit the provider from contracting with other state contractors; and
g. Provide a copy of a Member’s medical record at no charge upon re...
Provider Agreements. The Contractor must have a process in place to review and authorize all network provider agreements. The Contractor must submit a model or sample contract of each type of provider agreement to FSSA for review and approval at least sixty (60) calendar days prior to the Contractor’s intended use. Sample contracts should also be submitted by Respondents. The Contractor must notify FSSA of any changes to the sample contracts provided with the RFP response within three (3) weeks of the Contract award date.
