Common use of Provider Network Clause in Contracts

Provider Network. The “provider network” is the panel of health service providers with which the CCO contracts for the provision of covered services to beneficiaries. All CCO contracted providers must also be enrolled in the Mississippi Medicaid program. CCOs will be required to recruit and maintain a provider network, using provider contracts as approved by the Division that includes all types of Medicaid providers and the full range of medical specialties necessary to provide the covered benefits, including contracts with out-of-state providers for medically necessary services. In establishing its provider network, CCOs will be required to contract with Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Access standards for the provider network will require the CCOs to insure that for primary care services members travel no more than sixty (60) minutes or sixty (60) miles in the rural regions and thirty (30) minutes or thirty (30) miles in the urban regions. As access to non-hospital based emergency care is an issue of concern, CCOs will be required to include non-hospital urgent and emergent care providers in their networks. The Contractor, subcontractor, nor representatives of Contractor shall provide false or misleading information to providers in an attempt to recruit providers for the Contractor’s network. The Contractor shall not discriminate against providers with respect to participation, reimbursement, or indemnification for any provider acting within the scope of that provider’s license or certification under applicable State law or regulation solely on the basis of the provider’s license or certification.

Provider Network. The “provider network” is the panel of health service providers with which the CCO Contractor contracts for the provision of covered services to beneficiaries. All CCO Contractor contracted providers must also be enrolled in the Mississippi Medicaid program. CCOs Contractor will be required to recruit and maintain a provider network, using provider contracts as approved by the Division that includes all types of Medicaid providers and the full range of medical specialties necessary to provide the covered benefits, including contracts with out-of-state providers for medically necessary services. In establishing its provider network, CCOs Contractor will be required to contract with Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Access standards for the provider network will require the CCOs Contractor to insure that for primary care services members travel no more than sixty (60) minutes or sixty (60) miles in the rural regions and thirty (30) minutes or thirty (30) miles in the urban regions. As access to non-hospital based emergency care is an issue of concern, CCOs Contractor will be required to include non-hospital urgent and emergent care providers in their networks. The Contractor, subcontractor, nor representatives of Contractor shall provide false or misleading information to providers in an attempt to recruit providers for the Contractor’s network. The Contractor shall not discriminate against providers with respect to participation, reimbursement, or indemnification for any provider acting within the scope of that provider’s license or certification under applicable State law or regulation solely on the basis of the provider’s license or certification.