{"component": "clause", "props": {"groups": [{"samples": [{"hash": "lPjmtXmGhuv", "uri": "/contracts/lPjmtXmGhuv#provider-compensation", "label": "Service Agreement", "score": 31.9705085754, "published": true}, {"hash": "9KNgd7FAnL2", "uri": "/contracts/9KNgd7FAnL2#provider-compensation", "label": "Amendment", "score": 29.8216743469, "published": true}, {"hash": "bDPUa2jiFUA", "uri": "/contracts/bDPUa2jiFUA#provider-compensation", "label": "Standard Agreement", "score": 29.4037189484, "published": true}], "snippet": "The Contractor shall ensure that no payment is made to a network provider other than payment the Contractor makes for services covered under this Contract, except when these payments are specifically required to be made by the state in Title XIX of the Act, in 42 Code of Federal Regulations in chapter IV, or when the state agency makes direct payments to network providers for graduate medical education costs approved under the State Plan. (42 C.F.R. \u00a7 438.60.)", "size": 12, "snippet_links": [{"key": "the-contractor-shall", "type": "clause", "offset": [0, 20]}, {"key": "no-payment", "type": "clause", "offset": [33, 43]}, {"key": "services-covered", "type": "clause", "offset": [118, 134]}, {"key": "under-this-contract", "type": "clause", "offset": [135, 154]}, {"key": "by-the-state", "type": "clause", "offset": [220, 232]}, {"key": "title-xix", "type": "definition", "offset": [236, 245]}, {"key": "the-act", "type": "clause", "offset": [249, 256]}, {"key": "code-of-federal-regulations", "type": "definition", "offset": [264, 291]}, {"key": "chapter-iv", "type": "definition", "offset": [295, 305]}, {"key": "state-agency", "type": "clause", "offset": [319, 331]}, {"key": "payments-to", "type": "definition", "offset": [345, 356]}, {"key": "network-providers", "type": "clause", "offset": [357, 374]}, {"key": "medical-education-costs", "type": "definition", "offset": [388, 411]}, {"key": "state-plan", "type": "definition", "offset": [431, 441]}], "hash": "76d52a22de0f69b4f31bfd801606ef25", "id": 1}, {"samples": [{"hash": "b0xuuLgxKv5", "uri": "/contracts/b0xuuLgxKv5#provider-compensation", "label": "Service Agreement", "score": 34.2808456421, "published": true}, {"hash": "cQybtrdPzMV", "uri": "/contracts/cQybtrdPzMV#provider-compensation", "label": "Service Agreement", "score": 33.8602130129, "published": true}, {"hash": "at7CxyDMftP", "uri": "/contracts/at7CxyDMftP#provider-compensation", "label": "Standard Agreement", "score": 32.6392860413, "published": true}], "snippet": "The Department shall ensure that no payment is made to a network provider other than by the Contractor for services covered under this agreement, except when these payments are specifically required to be made by the Department in Title XIX of the Act, in 42 CFR chapter IV. (42 C.F.R. \u00a7 438.60.)", "size": 5, "snippet_links": [{"key": "the-department-shall", "type": "clause", "offset": [0, 20]}, {"key": "no-payment", "type": "clause", "offset": [33, 43]}, {"key": "network-provider", "type": "definition", "offset": [57, 73]}, {"key": "by-the-contractor", "type": "clause", "offset": [85, 102]}, {"key": "services-covered", "type": "clause", "offset": [107, 123]}, {"key": "this-agreement", "type": "clause", "offset": [130, 144]}, {"key": "by-the-department", "type": "clause", "offset": [210, 227]}, {"key": "title-xix", "type": "definition", "offset": [231, 240]}, {"key": "the-act", "type": "clause", "offset": [244, 251]}, {"key": "chapter-iv", "type": "definition", "offset": [263, 273]}], "hash": "45b1842773b9a8e621f624e0d9e0401e", "id": 2}, {"samples": [{"hash": "fQSEso2aEmk", "uri": "/contracts/fQSEso2aEmk#provider-compensation", "label": "Ancillary Participation Agreement", "score": 31.3408622742, "published": true}, {"hash": "hVktPH4ncB3", "uri": "/contracts/hVktPH4ncB3#provider-compensation", "label": "Ancillary Participation Agreement (Certified Diabetic Services Inc)", "score": 21.0, "published": true}, {"hash": "bnfj1kJDztc", "uri": "/contracts/bnfj1kJDztc#provider-compensation", "label": "Ancillary Participation Agreement (Certified Diabetic Services Inc)", "score": 21.0, "published": true}], "snippet": "Provider shall be compensated for the provision of Covered Services to Members based on the compensation system set forth in Exhibit A of this Agreement, as may be amended from time to time.", "size": 5, "snippet_links": [{"key": "provider-shall", "type": "clause", "offset": [0, 14]}, {"key": "services-to-members", "type": "clause", "offset": [59, 78]}, {"key": "based-on", "type": "definition", "offset": [79, 87]}, {"key": "compensation-system", "type": "clause", "offset": [92, 111]}, {"key": "exhibit-a", "type": "definition", "offset": [125, 134]}, {"key": "this-agreement", "type": "clause", "offset": [138, 152]}, {"key": "from-time-to-time", "type": "clause", "offset": [172, 189]}], "hash": "41ca427912cbab862fc66265976f2745", "id": 3}, {"samples": [{"hash": "d8a701DM9UB", "uri": "/contracts/d8a701DM9UB#provider-compensation", "label": "Agreement (Planetrx Com)", "score": 18.0, "published": true}, {"hash": "5Ht2Gtlgiqp", "uri": "/contracts/5Ht2Gtlgiqp#provider-compensation", "label": "Termination Agreement (Express Scripts Inc)", "score": 18.0, "published": true}, {"hash": "5AG7gIFR0LJ", "uri": "/contracts/5AG7gIFR0LJ#provider-compensation", "label": "Agreement (Planetrx Com)", "score": 18.0, "published": true}], "snippet": "A. Reimbursement Pricing -- 30-", "size": 4, "snippet_links": [], "hash": "f3d48d1e404edf769ca4036e76037b69", "id": 4}, {"samples": [{"hash": "eincUjLnaPX", "uri": "/contracts/eincUjLnaPX#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 33.6546020508, "published": true}, {"hash": "tDy37iIcE", "uri": "/contracts/tDy37iIcE#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 32.9294471741, "published": true}, {"hash": "7vGf1gogrdD", "uri": "/contracts/7vGf1gogrdD#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 28.8983211517, "published": true}], "snippet": "Members may request information about Plan\u2019s EAP Provider reimbursement policies and procedures by contacting Plan\u2019s Manager, Provider Relations, at \u2587-\u2587\u2587\u2587-\u2587\u2587\u2587-\u2587\u2587\u2587\u2587 or the Member's EAP Provider.", "size": 3, "snippet_links": [{"key": "request-information", "type": "clause", "offset": [12, 31]}, {"key": "procedures-by", "type": "clause", "offset": [85, 98]}, {"key": "provider-relations", "type": "clause", "offset": [126, 144]}, {"key": "the-member", "type": "clause", "offset": [167, 177]}], "hash": "fb4e953843a4f339265f36c79a681add", "id": 5}, {"samples": [{"hash": "eincUjLnaPX", "uri": "/contracts/eincUjLnaPX#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 33.6546020508, "published": true}, {"hash": "tDy37iIcE", "uri": "/contracts/tDy37iIcE#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 32.9294471741, "published": true}, {"hash": "7vGf1gogrdD", "uri": "/contracts/7vGf1gogrdD#provider-compensation", "label": "Employee Assistance Program Services Agreement", "score": 28.8983211517, "published": true}], "snippet": "A. Plan compensates EAP Providers through an agreement by which they are paid a fixed amount of money based on hours worked, number of Members seen, or number of sessions provided. Providers are compensated within thirty (30) days after a claim is received.\nB. Plan does not distribute financial bonuses or use any other incentive program to compensate its EAP Providers other than the methods of compensation defined above.", "size": 3, "snippet_links": [{"key": "an-agreement", "type": "clause", "offset": [42, 54]}, {"key": "fixed-amount", "type": "clause", "offset": [80, 92]}, {"key": "based-on", "type": "definition", "offset": [102, 110]}, {"key": "hours-worked", "type": "definition", "offset": [111, 123]}, {"key": "number-of-members", "type": "definition", "offset": [125, 142]}, {"key": "number-of-sessions", "type": "clause", "offset": [152, 170]}, {"key": "within-thirty", "type": "clause", "offset": [207, 220]}, {"key": "days-after", "type": "definition", "offset": [226, 236]}, {"key": "incentive-program", "type": "clause", "offset": [321, 338]}, {"key": "to-compensate", "type": "clause", "offset": [339, 352]}, {"key": "defined-above", "type": "clause", "offset": [410, 423]}], "hash": "f2db3471eb5e6b802a18aafc4c0783bf", "id": 6}, {"samples": [{"hash": "iSrcAcjyfxW", "uri": "/contracts/iSrcAcjyfxW#provider-compensation", "label": "Practice Management Services Agreement (Integrated Physician Systems Inc)", "score": 18.0, "published": true}, {"hash": "eF44W2GBiQ4", "uri": "/contracts/eF44W2GBiQ4#provider-compensation", "label": "Practice Management Services Agreement (Integrated Physician Systems Inc)", "score": 18.0, "published": true}], "snippet": "As compensation for the services rendered at the Practice Sites, Provider shall receive compensation as set forth on Appendix \"A\", attached hereto and made a part hereof (\"Provider Compensation\"). With respect to any partial calendar years during which this Agreement is in effect, Provider Compensation shall be prorated according to the number of calendar days actually elapsed during such partial calendar year.", "size": 2, "snippet_links": [{"key": "services-rendered", "type": "definition", "offset": [24, 41]}, {"key": "practice-sites", "type": "clause", "offset": [49, 63]}, {"key": "provider-shall", "type": "clause", "offset": [65, 79]}, {"key": "with-respect-to", "type": "clause", "offset": [197, 212]}, {"key": "calendar-years", "type": "clause", "offset": [225, 239]}, {"key": "this-agreement", "type": "clause", "offset": [253, 267]}, {"key": "in-effect", "type": "clause", "offset": [271, 280]}, {"key": "according-to", "type": "definition", "offset": [322, 334]}, {"key": "number-of", "type": "definition", "offset": [339, 348]}, {"key": "calendar-days", "type": "definition", "offset": [349, 362]}], "hash": "ce4df528a19ec6cac55d13c37fd64249", "id": 7}, {"samples": [{"hash": "8W1dV4GA3CH", "uri": "/contracts/8W1dV4GA3CH#provider-compensation", "label": "Purchase of Service Contract (Wellcare Health Plans, Inc.)", "score": 18.0, "published": true}], "snippet": "a. The MCO shall comply with HCFA's Physician Incentive Plan (PIP) requirements in 42 CFR 434.70. The MCO may operate a PIP only if:\n1. no specific payment can be made directly or indirectly under a PIP to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual Member; and\n2. the stop-loss protection, Member survey, and disclosure requirements of 42 C.F.R. 417.479 are met.\nb. The MCO shall disclose to the DEPARTMENT the following information on PIPs in sufficient detail to determine whether the incentive plan complies with the regulatory requirements of 42 CFR 417.479. The disclosure must contain:\n1. Whether services not furnished by the physician or physician group are covered by the PIP. If only the services furnished by the physician or physician group are covered by the incentive plan, disclosure of other aspects of the plan need not be made.\n2. The type of incentive arrangement (i.e. withhold, bonus, capitation).\n3. If the incentive plan involves a withhold or bonus, the percent of the withhold or bonus.\n4. Proof that the physician or physician group has adequate stop-loss protection, including the amount and type of stop-loss protection.\n5. The panel size and, if patients are pooled, the method used.\n6. In the case of those MCOs that are required by 42 C.F.R. 417.479 provision to conduct Member surveys, the survey results.\nc. The MCO shall disclose this information to the DEPARTMENT (1) prior to approval of its contract as required by federal regulation and (2) upon the contract anniversary or renewal effective date. The MCO shall provide the capitation data required (see (6) above) for the previous contract year to the DEPARTMENT three (3) months after the end of the contract year. The MCO will provide to the Member upon request information regarding whether the MCO uses a physician incentive plan that affects the use of referral services, the type of incentive arrangement, whether stop-loss protection is provided, and the survey results of any Member survey conducted. See Appendix J for the applicable regulations and disclosure forms.\nd. The DEPARTMENT may impose Class C sanctions pursuant to Section 7.05 for failure to comply with 42 C.F.R. 417.479", "size": 2, "snippet_links": [{"key": "physician-incentive-plan", "type": "definition", "offset": [36, 60]}, {"key": "directly-or-indirectly", "type": "clause", "offset": [168, 190]}, {"key": "physician-group", "type": "definition", "offset": [221, 236]}, {"key": "medically-necessary-services", "type": "definition", "offset": [273, 301]}, {"key": "individual-member", "type": "definition", "offset": [318, 335]}, {"key": "loss-protection", "type": "clause", "offset": [353, 368]}, {"key": "disclosure-requirements", "type": "clause", "offset": [389, 412]}, {"key": "the-department", "type": "clause", "offset": [472, 486]}, {"key": "information-on", "type": "clause", "offset": [501, 515]}, {"key": "sufficient-detail", "type": "clause", "offset": [524, 541]}, {"key": "determine-whether", "type": "clause", "offset": [545, 562]}, {"key": "the-incentive", "type": "clause", "offset": [563, 576]}, {"key": "regulatory-requirements", "type": "clause", "offset": [600, 623]}, {"key": "covered-by", "type": "definition", "offset": [746, 756]}, {"key": "services-furnished-by", "type": "clause", "offset": [778, 799]}, {"key": "disclosure-of", "type": "clause", "offset": [868, 881]}, {"key": "other-aspects", "type": "clause", "offset": [882, 895]}, {"key": "the-plan", "type": "clause", "offset": [899, 907]}, {"key": "type-of", "type": "definition", "offset": [933, 940]}, {"key": "incentive-arrangement", "type": "definition", "offset": [941, 962]}, {"key": "amount-and-type", "type": "clause", "offset": [1188, 1203]}, {"key": "panel-size", "type": "definition", "offset": [1236, 1246]}, {"key": "the-method", "type": "definition", "offset": [1276, 1286]}, {"key": "in-the-case", "type": "clause", "offset": [1296, 1307]}, {"key": "survey-results", "type": "clause", "offset": [1402, 1416]}, {"key": "prior-to", "type": "definition", "offset": [1483, 1491]}, {"key": "approval-of", "type": "definition", "offset": [1492, 1503]}, {"key": "as-required-by", "type": "clause", "offset": [1517, 1531]}, {"key": "federal-regulation", "type": "definition", "offset": [1532, 1550]}, {"key": "contract-anniversary", "type": "definition", "offset": [1568, 1588]}, {"key": "renewal-effective-date", "type": "definition", "offset": [1592, 1614]}, {"key": "provide-the", "type": "clause", "offset": [1630, 1641]}, {"key": "data-required", "type": "clause", "offset": [1653, 1666]}, {"key": "contract-year", "type": "clause", "offset": [1700, 1713]}, {"key": "end-of-the-contract", "type": "clause", "offset": [1759, 1778]}, {"key": "will-provide", "type": "clause", "offset": [1793, 1805]}, {"key": "to-the-member", "type": "clause", "offset": [1806, 1819]}, {"key": "information-regarding", "type": "clause", "offset": [1833, 1854]}, {"key": "referral-services", "type": "definition", "offset": [1927, 1944]}, {"key": "appendix-j", "type": "clause", "offset": [2082, 2092]}, {"key": "applicable-regulations", "type": "definition", "offset": [2101, 2123]}, {"key": "disclosure-forms", "type": "clause", "offset": [2128, 2144]}, {"key": "class-c", "type": "definition", "offset": [2175, 2182]}, {"key": "pursuant-to-section", "type": "definition", "offset": [2193, 2212]}, {"key": "failure-to-comply-with", "type": "clause", "offset": [2222, 2244]}], "hash": "a41fa52232272c26d4c8c8e50432df14", "id": 8}, {"samples": [{"hash": "95cNBaYtiZp", "uri": "/contracts/95cNBaYtiZp#provider-compensation", "label": "Motor Vehicle Service Provider Agreement", "score": 24.3319644928, "published": true}], "snippet": "9.1 Provider is entitled to no compensation from MVD under this Agreement.\n9.2 In addition to the fees established by statute for each service provided by Provider, Provider shall reimburse TRD a cost recovery fee of two dollars ($2.00) for each service provided by Provider for which Provider charges Provider\u2019s customers a service fee. The cost recovery fee is not a charge by MVD or TRD to Company\u2019s customers and may not be described as such to Provider\u2019s customers. Any written communication to Provider\u2019s customers regarding the $2.00 cost recovery fee must be approved by MVD.\n9.3 Notwithstanding anything to the contrary contained herein, Provider shall have the right to assess its own fee for each customer transaction.", "size": 1, "snippet_links": [{"key": "no-compensation", "type": "clause", "offset": [28, 43]}, {"key": "this-agreement", "type": "clause", "offset": [59, 73]}, {"key": "to-the-fees", "type": "clause", "offset": [91, 102]}, {"key": "service-provided", "type": "clause", "offset": [135, 151]}, {"key": "by-provider", "type": "clause", "offset": [152, 163]}, {"key": "provider-shall", "type": "clause", "offset": [165, 179]}, {"key": "cost-recovery-fee", "type": "clause", "offset": [196, 213]}, {"key": "provider-charges", "type": "definition", "offset": [285, 301]}, {"key": "service-fee", "type": "clause", "offset": [325, 336]}, {"key": "the-cost", "type": "clause", "offset": [338, 346]}, {"key": "to-company", "type": "definition", "offset": [390, 400]}, {"key": "to-provider", "type": "definition", "offset": [446, 457]}, {"key": "communication-to", "type": "clause", "offset": [483, 499]}, {"key": "approved-by", "type": "definition", "offset": [567, 578]}, {"key": "notwithstanding-anything-to-the-contrary-contained", "type": "clause", "offset": [588, 638]}, {"key": "right-to", "type": "definition", "offset": [671, 679]}, {"key": "customer-transaction", "type": "definition", "offset": [708, 728]}], "hash": "21edba50e6031d2f4865417d150c6d0f", "id": 9}, {"samples": [{"hash": "8W1dV4GA3CH", "uri": "/contracts/8W1dV4GA3CH#provider-compensation", "label": "Purchase of Service Contract (Wellcare Health Plans, Inc.)", "score": 18.0, "published": true}], "snippet": "The MCO shall comply with CMS's Physician Incentive Plan (PIP) requirements in 42 CFR 422.208 and 42 CFR 422.210. The MCO may operate a PIP only if:", "size": 1, "snippet_links": [{"key": "comply-with", "type": "definition", "offset": [14, 25]}, {"key": "physician-incentive-plan", "type": "definition", "offset": [32, 56]}], "hash": "8730805612983040c59a1890b459c1b5", "id": 10}], "next_curs": "Cl4SWGoVc35sYXdpbnNpZGVyY29udHJhY3RzcjoLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2Ih5wcm92aWRlci1jb21wZW5zYXRpb24jMDAwMDAwMGEMogECZW4YACAA", "clause": {"children": [["remittance-advices", "Remittance Advices"], ["fulfillment-pricing", "Fulfillment Pricing"], ["order-fees", "Order Fees"], ["preferred-product-fees", "Preferred Product Fees"], ["taxes", "Taxes"]], "parents": [["therapeutic-behavioral-services", "Therapeutic Behavioral Services"], ["continuous-hours-of-operation", "Continuous Hours of Operation"], ["conflict-of-interest", "Conflict of Interest"], ["provider-compensation-and-\u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587", "Provider Compensation and \u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2587"], ["services-to-be-performed", "Services to be Performed"]], "size": 40, "title": "Provider Compensation", "id": "provider-compensation", "related": [["intercarrier-compensation", "Intercarrier Compensation", "Intercarrier Compensation"], ["services-and-compensation", "Services and Compensation", "Services and Compensation"], ["professional-compensation", "PROFESSIONAL COMPENSATION", "PROFESSIONAL COMPENSATION"], ["extra-compensation", "Extra Compensation", "Extra Compensation"], ["termination-compensation", "Termination Compensation", "Termination Compensation"]], "related_snippets": [], "updated": "2025-07-10T04:27:38+00:00"}, "json": true, "cursor": ""}}