What Is A Provider Agreement

    Out-network means a hospital, doctor or other provider of medical services and providers that do not have a contract to provide negotiated services for your coverage under a networked service provider contract with us for the Géc network. 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. Based on the information available to the supplier, the supplier undertakes to send the invoices first to the payer who appears to be the main person responsible for paying the invoices for services provided. If a managed care plan is the secondary payer, the managed care plan is only for the difference between what the supplier received or should have received from the primary payer and what the supplier would receive from the Managed Care Plan if the managed care plan had been the primary payer. Based on the information available to the supplier, the supplier undertakes to cooperate with managed care plans in order to identify other payers with whom members are insured. 2.21 Requirements in the event that a managed care plan ceases to operate: in the event that a managed care plan ceases to operate, the provider would agree to continue to provide covered services for the period for which the premium was paid, and the provider agrees that benefits are limited to members who, on the date of the bankruptcy of the managed care plan , or another company shutdown. , until the member is fired. The requirements of this section remain beyond the termination of the agreement, regardless of the reason for termination, including, but not only, the bankruptcy of SelectHealth or an associated care plan. This section is interpreted to benefit members and individuals acting on behalf of members. The provisions of this section replace an oral or written agreement currently reached between the supplier and a member or person acting on behalf of a member, to the extent that such an agreement to the contrary relates to the liability of the covered services provided under this agreement.

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