Core Provider Agreement
A core provider agreement is a legal document that establishes a relationship between a healthcare provider and an insurance company. It outlines the terms of the agreement, including the services that the healthcare provider agrees to offer to the insurance company`s members, the payment rates that the insurance company agrees to pay for those services, and any other requirements that the healthcare provider must meet in order to participate in the insurance company`s network.
In many cases, healthcare providers are required to sign a core provider agreement in order to participate in an insurance company`s network. This is because insurance companies want to ensure that their members have access to high-quality healthcare services, and that the services provided are in line with the insurance company`s standards.
The core provider agreement typically includes several key provisions, including:
– Service requirements: This section outlines the types of services that the healthcare provider agrees to offer to the insurance company`s members. This may include specific medical procedures, diagnostic tests, or other healthcare services.
– Payment rates: The core provider agreement also specifies the payment rates that the insurance company agrees to pay for each service. Healthcare providers may negotiate these rates to some extent, but they are typically set by the insurance company.
– Quality standards: In order to participate in the insurance company`s network, healthcare providers must meet certain quality standards. The core provider agreement may outline these standards and specify any penalties for failing to meet them.
– Termination provisions: The core provider agreement may also include provisions outlining the circumstances under which the agreement may be terminated. This may include breaches of the agreement`s terms, changes to the healthcare provider`s services or payment rates, or other factors.
Overall, the core provider agreement is an important document for healthcare providers who want to participate in an insurance company`s network. By signing this agreement, healthcare providers agree to offer high-quality services to the insurance company`s members, and in return, they gain access to a wider patient population and guaranteed payment for their services. It is important for healthcare providers to carefully review the terms of the core provider agreement before signing, and to negotiate any provisions that may not be in their best interest.
