Provider incentive plan definition

Provider incentive plan means any compensation arrangement between a health
View Source
Provider incentive plan means any compensation arrangement between a health care entity or health plan and a provider or provider group that may directly or indirectly have the effect of reducing or limiting services provided with respect to an individual enrolled in a health plan.
View Source

Examples of Provider incentive plan in a sentence

  • Whether the Provider incentive plan covers services that are not furnished by a Provider or Provider group.

  • The Dental Contractor must not make payments under a Provider incentive plan if the payments are designed to induce Providers to reduce or limit Medically Necessary Covered Dental Services to Dental Members.

  • If the Provider incentive plan places a Provider or Provider group at a substantial financial risk for services not provided by the Provider or Provider group, the Dental Contractor must ensure adequate stop-loss protection and conduct and submit annual Dental Member surveys no later than five Business Days after the Dental Contractor finalizes the survey results.

  • If the Dental Contractor implements a Provider incentive plan under 42 C.F.R. § 438.6(h), the plan must comply with all applicable law, including 42 C.F.R. §§ 422.208 and 422.210.