Provider Protection Plan Clause Samples
The Provider Protection Plan clause is designed to safeguard the interests of the service provider in a contractual relationship. Typically, this clause outlines specific measures such as indemnification, liability limitations, or insurance requirements that protect the provider from certain risks or claims arising from the provision of services. For example, it may require the client to cover legal costs if the provider is sued due to the client's actions, or set caps on the provider's financial liability. The core function of this clause is to allocate risk and provide a clear framework for managing potential liabilities, thereby offering the provider greater security and predictability in the engagement.
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Provider Protection Plan. The MCO must comply with HHSC's provider protection plan requirements for reducing the administrative burdens placed on Network Providers, and ensuring efficiency in Network enrollment and reimbursement. At a minimum, the plan must comply with the requirements of Texas Government Code § 533.0055, and: • Provide for timely and accurate claims adjudication and proper claims payment in accordance with UMCM Chapters 2.0 through 2.2. • Include Network Provider training and education on the requirements for claims submission and appeals, including the MCO's policies and procedures (see also Section 8.1.4.6, "Provider Relations Including Manual, Materials and Training.") • Ensure Member access to care, in accordance with Section 8.1.3, "Access to Care," and the UMCM's Geo-Mapping requirements (see UMCM Chapters 5.14.1 through 5.14.4.) • Ensure prompt credentialing, as required by Section 8.1.4.4, "Provider Credentialing and Re-credentialing." • Ensure compliance with state and federal standards regarding prior authorizations, as described in Sections 8.1.8, "Utilization Management," and 8.1.21.2, "Prior Authorization for Prescription Drugs and 72-Hour Emergency Supplies." • Include other measures developed by HHSC or a provider protection plan workgroup, or measures developed by the MCO and approved by HHSC. Additionally, the MCO must participate in HHSC's work group, which will develop recommendations and proposed timelines for other components of the provider protection plan.