Provider Agreement Definition

11 Apr 2021


Provider Agreement Definition

In order to avoid delays related to delays in the re-induction of modified administrative documents, you should check in advance whether the terms of the model agreement are broadly applicable and whether the provisions need to be changed and how often. A suspension of payment may also be necessary when, for example. B, a supplier is under investigation for alleged fraud or other reasons, and the agreement should expressly state this. The offer agreement should also specify all rights of appeal that the supplier may have after receiving termination by the health plan (with, if applicable, references to the supplier`s manual). As a preliminary comment, you should receive a copy of the health plan provider`s guide. Offer agreements generally contain the supplier`s manual, which often contains detailed discussions on important issues such as registration information, application submission, appeal rights and maintenance of medical records. As part of the supplier agreement design process, check the supplier`s guide to ensure it reflects the latest legal and regulatory requirements, as well as the unique processes and procedures of the health plan. 2.La second category relates to incentive schemes that tend to discriminate against persons with disabilities and the claimants who treat them. 4.02 Termination in the event of termination: the agreement may be terminated after written notification to the supplier for one of the following reasons: (i) any action requiring the supplier to terminate the contract in accordance with Section 2.17 of this agreement, and SelectHealth reasonably considers that the supplier`s ability to meet the supplier`s obligations under this agreement could be significantly compromised.

, or (ii) the supplier is or is currently abusing alcohol or drugs. The health plan should also review its relevant government laws to determine whether it is required to terminate a supplier within a specified time frame after a supplier`s licence has been limited, limited, sanctioned or revoked. If this is the case, the deadlines for reporting the agreement should take into account that date. However, be careful not to create new rights to appeal a termination decision that is not due to the person to whom the provider is legally eligible or which is stipulated in the supplier`s guide or in other applicable health plan policies and procedures. Participating suppliers agree to accept payment under the health plan for own rights, in accordance with the terms set out in the supplier agreement. Own rights are defined in the supplier agreement, with definitions most often directly derived from government insurance legislation and regulation. It is a good place to define the health plan process for the handling of incomplete claims in the provider agreement or, at the very least, to indicate where a provider can find this information (for example. B supplier manual). For its part, the health plan must be paid for by providers under government payment legislation. The supplier agreement must reflect the corresponding payment times.

If the health plan wants to retain the right to recover funds paid to suppliers for any reason (for example. B in the event of overpayment through the supplier`s health plan), the offer agreement should clearly define this right and describe how the recovery process might work. Under the terms of the Preferred Provider Agreement, the health care provider is committed to providing the services covered by the performance plan to the patients included in the plan.