Common use of Network Provider Services Clause in Contracts

Network Provider Services. The TPA will hire and maintain sufficient provider relations and customer service staff to meet the needs of the Board and the participants. The TPA will report quarterly on the volume of calls received and the types of calls received. The TPA must staff a provider services department to be operated at least during regular business hours (e.g. 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday). The TPA must maintain a provider service office within the state of Mississippi throughout the term of the contract. Provider services staff must be proficient in: 1. Assisting providers with prior authorization and referral procedures, including the use of non- participating providers; 2. Assisting providers with claims payment procedures including electronic submission of claims in accordance with HIPAA and HITECH electronic data interchange (EDI) standards; 3. Handling provider complaints and grievances; 4. Educating providers as to their responsibilities under the Plan; 5. Educating providers as to covered medical services, excluded medical services and benefit limitations; and 6. Facilitation of medical record transfer among providers as necessary.