Provider Agreements. The Contractor must have a process in place to review and authorize all network provider contracts. The Contractor must submit a model or sample contract of each type of provider agreement to OMPP for review and approval at least sixty (60) calendar days prior to the Contractor’s intended use. The Contractor must notify OMPP of any changes to the sample contracts within three (3) weeks of the Contract award date. To allow sufficient processing time for the enrollment of the PMP and ensure an effective date of January 1, 2017, the Contractor shall submit the completed PMP enrollment request to the State fiscal agent through the WebInterchange-Provider Healthcare Portal by December 1, 2016. The Contractor shall include in all of its provider agreements provisions to ensure continuation of benefits. The Contractor shall identify and incorporate the applicable terms of its Contract with the State and any incorporated documents. Under the terms of the provider services agreement, the provider shall agree that the applicable terms and conditions set out in the Contract, any incorporated documents, and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to members. The requirement set forth in Section 2.7 that subcontractors indemnify and hold harmless the State of Indiana do not extend to the contractual obligations and agreements between the Contractor and health care providers or other ancillary medical providers that have contracted with the Contractor. In addition to the applicable requirements for subcontracts in Section 2.7, the provider agreements shall meet the following requirements: Describe a written provider claim dispute resolution process. Require each provider to maintain a current IHCP provider agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board. Require each provider to submit all claims that do not involve a third party payer for services rendered to the Contractor’s members within ninety (90) calendar days or less from the date of service. The Contractor shall waive the timely filing requirement in the case of claims for members with retroactive coverage, such as presumptively eligible pregnant women and newborns. Require each provider to utilize the Indiana Health Coverage Program Prior Authorization Request Form available on the Indiana Medicaid website for s...
Provider Agreements. The Practice shall not enter into contractual arrangements with third parties for the Practice's provision of Professional Eye Care Services which are inconsistent with guidelines established by the Local Advisory Council or any capitated fee arrangement without the prior approval of the Practice Advisory Council. Subject to the foregoing provision, the Practice shall have the final authority with regard to all of such contractual arrangements.
Provider Agreements. The Contractor must have a process in place to review and authorize all network provider agreements. The Contractor must submit a model or sample contract of each type of provider agreement to FSSA for review and approval at least sixty (60) calendar days prior to the Contractor’s intended use. Sample contracts should also be submitted by Respondents. The Contractor must notify FSSA of any changes to the sample contracts provided with the RFP response within three (3) weeks of the Contract award date. The Contractor must include in all of its provider agreements provisions to ensure continuation of benefits. The Contractor must identify and incorporate the applicable terms of the Contract with the State. Under the terms of the provider agreement, the provider must agree that the applicable terms and conditions set out in the Contract and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to members. The requirement set forth in Section 2.3 that subcontracts indemnify and hold harmless the State of Indiana does not extend to the contractual obligations and agreements between the Contractor and health care providers or other ancillary medical providers that have contracted with the Contractor. In addition to the applicable requirements for subcontracts in Section 2.3, the provider agreements must meet the following requirements: Describe a written provider claim dispute resolution process. Require each provider to maintain a current IHCP provider agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board. Require each provider to submit all claims that do not involve a third party payer for services rendered to the Contractor’s members within ninety (90) calendar days or less from the date of service. Include a termination clause stipulating that the Contractor must terminate its contractual relationship with the provider as soon as the Contractor has knowledge that the provider’s license or IHCP provider agreement has terminated. Terminate the provider’s agreement to serve the Contractor’s Hoosier Care Connect members at the end of the Contract with the State. Monitor providers and apply corrective actions for those who are out of compliance with FSSA’s or the Contractor’s standards. Obligate the terminating provider to submit all encounter claims for services rendered to th...
Provider Agreements. The CHC-MCO must have written Provider Agreements with a sufficient number of Providers to provide Participant access to all Covered Services as set forth in Exhibit BB Provider Network Composition/Service Access. The requirements for these Provider Agreements are set forth in Exhibit DD, CHC-MCO Provider Agreements.
Provider Agreements. Contractor shall include in its Network Provider agreements, a provision requiring as a condition of receiving payment, that the Provider comply with section 5.35 of this Contract.
Provider Agreements. The Facility has current provider agreements under Titles XVIII and XIX of the Social Security Act.
Provider Agreements. The Contractor shall not include covenant-not-to-compete requirements in its provider agreements. Specifically, the Contractor shall not contract with a provider and require that the provider not provide services for any other AHCCCS Contractor. In addition, the Contractor shall not enter into subcontracts that contain compensation terms that discourage providers from serving any specific eligibility category. The Contractor must make reasonable efforts to enter into a written agreement with any provider providing services at the request of the Contractor more than 25 times during the previous contract year and/or are anticipated to continue providing services for the Contractor. The Contractor must follow ACOM Policy 415 and consider the repeated use of providers operating without a written agreement when assessing the adequacy of its network. For all subcontracts in which the Contractor and subcontractor have a capitated arrangement/risk sharing arrangement, the following provision must be included verbatim in every contract: If <the Subcontractor> does not xxxx <the Contractor>, <the subcontractor’s> encounter data that is required to be submitted to <the Contractor> pursuant to contract is defined for these purposes as a “claim for payment”. <The subcontractor’s> provision of any service results in a “claim for payment” regardless of whether there is any intention of payment. All said claims shall be subject to review under any and all fraud and abuse statutes, Rules and regulations, including but not limited to Arizona Revised Statute (A.R.S.) §36-2918. All subcontracts must reference and require compliance with the Minimum Subcontract Provisions. See Minimum Subcontract Provisions on the AHCCCS website at: xxxx://xxx.xxxxxxxx.xxx/commercial/MinimumSubcontractProvisions.aspx In addition, each subcontract must contain the following:
Provider Agreements. Schedule 2.25 sets forth a list of all Persons who are parties to provider agreements or similar Contracts for health care services, supplies or pharmaceuticals, and sets forth the number of covered lives serviced by each such Person. The Company has delivered to Parent copies of such agreements for the 20 largest providers doing business with the Company and each Company Subsidiary, on the basis of revenues collected or accrued for the twelve months ended March 31, 2002. Schedule 2.25 also designates those providers who through capitation or some other financial risk transfer arrangements have contractually assumed liability of ten percent or more for the delivery of specified health care services to members or subscribers. Except as disclosed in Schedule 2.25, to the knowledge of the Company, neither the Company nor either Company Subsidiary has violated any of the material terms or conditions of any provider agreement or similar Contract, other than violations which, individually or in the aggregate, could not reasonably be expected to result in the termination of such Contract or give rise to a claim which could reasonably be expected to require expenditures in excess of $50,000. Except as disclosed in Schedule 2.25, no such provider has ceased or materially reduced its provision of services to any plan beneficiary or group of the Company or either Company Subsidiary or has threatened to do so. Schedule 2.25 lists all of those provider agreements or similar Contracts which the Company or either Company Subsidiary intends not to renew, which Contract, if not renewed or replaced, could reasonably be expected to result in a Material Adverse Change.
Provider Agreements. Contractor’s Provider Agreements shall require that Network Providers submit benefit expense claim data, as defined in7.11.5.2, for all Covered Services provided to Enrollees.
Provider Agreements. Except when the Funding Area Description requires Activities falling within that Funding Area to be provided or conducted by County directly or expressly provided in the Plan, County may expend financial assistance provided under this Agreement for a particular Activity to purchase services comprising that Activity from a third person or entity (a "Provider") through a contract (a "Provider Agreement"). County may permit a Provider to purchase services comprising an Activity, from another person or entity under a subcontract and such subcontractors shall also be considered Providers for purposes of this Agreement. County shall not permit any person or entity to be a Provider unless the person or entity holds all licenses, certificates, authorizations and other approvals required by applicable law to deliver the services. The Provider Agreement must be in writing and contain each of the provisions that must be included in a Provider Agreement under the terms of this Agreement or in order to permit County to comply with its obligations under this Agreement with respect to the Activities conducted by the Provider. County shall maintain an originally executed copy of each Provider Agreement at its office and shall furnish a copy of any Provider Agreement to Agency upon request.
