What Is Provider Agreements

December 20, 2020 james

A good contract with a salaried or contract doctor or other doctor can help you avoid regulatory violations and future litigation. Here is a brief summary of some of the conditions or problems you need to consider in your supplier agreements. 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. The provider must also demonstrate that physicians, nurses and staff in that provider`s office have all the licenses and registration information necessary to perform the services they provide under the agreement. Independent clinics and small firm offices must follow this documentation as part of their government licensing procedures, so the provision of this evidence to performance plan administrators is often relatively painless. 1.12 Provider: The health care provider who subserance with SelectHealth under this agreement. While the decision is not binding on other courts, health care providers, if followed elsewhere, have the opportunity to sell their assets freely and without state liability in the event of bankruptcy, which should result in a higher price than would be achieved outside of bankruptcy. 2.28 Independent Contractors: Suppliers and selectHealth (and all related management plans, to the extent that they are third-party beneficiaries of this agreement), are independent contractors and the supplier is free to enter into similar agreements with other plans or companies. The provider understands and accepts that it is not the agent or employee of SelectHealth or an associated De Managed Care plan, and that it is not authorized to speak, represent or be related to SelectHealth or for an associated managed care plan. The supplier undertakes not to make a contrary answer to this section. The claimant`s employer is responsible for all employment taxes, income and other taxes arising from the claimant`s professional activity and payments made for these activities. Nothing in this agreement is interpreted as creating any other type of relationship.

Other responsibilities and restrictions in the provider`s relationship with managed care plans and members are specified elsewhere in this agreement. 2.04 Occupational Relations: The provider understands that neither SelectHealth nor Affiliated Managed Care Plans practice medicine and that they are not allowed to direct the treatment of patients. As SelectHealth and Affiliated Managed Care Plans establish practical protocols, usage management policies or quality improvement standards, these elements are not a substitute for the vendor`s professional judgment. The provider has a professional responsibility to establish an appropriate and independent provider – patient relationships with members to whom the provider provides covered services. The provider is responsible for providing appropriate medical care to members under its responsibility, regardless of the requirements of this agreement, a health care program, payment agreement or use management provision by SelectHealth or a related care management plan. The provider is solely responsible for the services provided to members. The process for submitting health care claims and subsequent payment to providers are standardized on providers, but the amount of compensation paid to different providers varies and is generally included in an appendix to the supplier agreement. 2.23 Service Coordination: The provider undertakes to cooperate with managed care plans to coordinate benefits and payments with other plans and payers who are or could be responsible for all or part of the covered services provided to members.