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A provider contract describes the responsibilities of each party to the contract. These responsibilities can be divided into provider responsibilities, health plan responsibilities, and mutual obligations. Mutual obligations typically include
ANSWER : B
From the following answer choices, choose the type of clause or provision described in this
The provider contract between Dr. Olin Norquist and the Granite Health Plan specifies a time period for the party who has breached the contract to remedy the problem and avoid termination of the contract.
ANSWER : A
The following statement(s) can correctly be made about contracting and reimbursement of specialty care physicians (SCPs):
A. Typically, a health plan should attempt to control utilization of SCPs before attempting to
place these providers under a capitation arrangement.
B. Forms of specialty physician reimbursement used by health plans include a retainer and a bundled case rate.
ANSWER : A
In health plan pharmacy networks, service costs consist of two components: costs for services associated with dispensing prescription drugs and costs for cognitive services. Cognitive services typically include:
ANSWER : B
The provider contract that Dr. Bijay Patel has with the Arbor Health Plan includes a nobalance-billing clause. The purpose of this clause is to:
A. prohibit Dr. Patel from collecting payments from Arbor plan members for medical
services that he provided them, even if the services are explicitly excluded from the benefit
B. allow Dr. Patel to bill patients for services only if the services are considered to be medically necessary
C. establish the guidelines used to determine if Arbor is the primary payor of benefits in a situation in which an Arbor plan member is covered by more than one health plan
D. require Dr. Patel to accept Arbor's payment as payment in full for medical services that he provides to Arbor plan members
ANSWER : D