Provider Relations Clause Samples
Provider Relations. A. Recognizing providers are the DCP Holding Company product - continually promote their skills, quality, cost-effectiveness and value to all public.
B. Establish leadership, stability and effective communication with all DCP Holding Company providers.
C. Continued awareness that the success of DCP Holding Company and their providers grow together.
Provider Relations. 4.9.4.1 The Contractor shall establish and maintain a formal Provider relations function to timely and adequately respond to inquiries, questions and concerns from network Providers. The Contractor shall implement policies addressing the compliance of Providers with the requirements of GF, institute a mechanism for Provider dispute resolution and execute a formal system of terminating Providers from the network.
4.9.4.2 The Contractor shall provide for a Provider Relations Liaison to carry out the Provider Relations functions. There shall be at least one (1) Provider Relations Liaison in each Service Region.
Provider Relations. The Health Plan shall establish and maintain a formal Provider relations function to timely and adequately respond to inquiries, questions and concerns from network Providers. The Health Plan shall implement policies addressing the compliance of Providers with the requirements of this Contract, institute a mechanism for Provider dispute resolution and execute a formal system of terminating Providers from the Health Plan’s network.
Provider Relations. The Contractor shall maintain staff to perform provider relation functions to include; training providers in the Contractor's procedures for authorization and claims payments, assisting providers to resolve billing and other administrative problems and responding to provider complaints about administrative processes.
Provider Relations. 2.18.7.1 The CONTRACTOR shall establish and maintain a formal provider relations function to provide ongoing troubleshooting and education for contract providers.
2.18.7.2 The CONTRACTOR shall provide one-on-one assistance to long-term care providers as needed to help long-term care providers submit clean and accurate claims and minimize claim denial. The CONTRACTOR shall develop and implement protocols, prior approved by TENNCARE, that specify the CONTRACTOR’s criteria for providing one-on-one assistance to a provider and the type of assistance the CONTRACTOR will provide. At a minimum, the CONTRACTOR shall contact a provider if, during the first year after implementation of CHOICES in the Grand Region covered by this Agreement, the CONTRACTOR has or will deny ten percent (10%) or more of the total value of the provider’s claims for a rolling thirty (30) day period, and shall, in addition to issuing a remittance advice, contact the provider to review each of the error(s)/reason(s) for denial and advise how the provider can correct the error for resubmission (as applicable) and avoid the error/reason for denial in the future.
2.18.7.3 The CONTRACTOR shall implement policies to monitor and ensure compliance of providers with the requirements of this Agreement.
2.18.7.4 The CONTRACTOR shall conduct an annual survey to assess provider satisfaction, including satisfaction with provider enrollment, provider communication, provider education, provider complaints, claims processing, claims reimbursement, care coordination, and utilization management processes, including medical reviews. The CONTRACTOR shall include questions specified by TENNCARE. The CONTRACTOR shall submit an annual report on the survey to TENNCARE as required in Section 2.30.12.
Provider Relations. TRI CO. will provide the following provider relations services: Make available to the providers the necessary provider applications and review them for completeness; recommend credentialing
Provider Relations. TOLL-FREE PROVIDER SERVICES TELEPHONE LINE
Provider Relations. Service Line; Provider Portal; Welcome Packet, iv. is revised and restated as follows:
Provider Relations. These processes deal with development, management, and monitoring of the CLIENT network of Affiliated Providers. All activities will be linked together by a unique Affiliated Provider identification number. The functional processes of viewing and editing/updating within this function are password protected to maintain the privacy of information and the integrity of the data. Affiliated Providers for which information will be stored includes, but is not limited to: physicians, para-professionals, hospitals, durable medical equipment suppliers, pharmacies, outpatient facilities, long term care facilities, etc. The information includes the multiplicity of medical management and financial relationships of the Affiliated Providers to each other, CLIENT, payors and patients, as well as the medical management and financial relationships of CLIENT with payors, patients, and other Providers.
Provider Relations. PA HRM shall assure that provider relations are managed to assure competent operation of the HC Program. PA HRM may select from among the Providers in the Provider Network only those Providers with whom PA HRM wishes to work. PA HRM shall not be obligated to use all Providers under contract to Oxford, but PA HRM may not terminate a Provider's Agreement without Oxford's consent. PA HRM shall not act in any manner to violate the terms of any Oxford Par Provider Agreement. PA HRM shall be authorized to enter into a pharmacy benefit management program agreement with ValueRX on or after the Effective Date to replace the existing agreement with PCS, subject to all required Regulatory Approvals from the State.