Provider Network Management Clause Samples

Provider Network Management. $100 per Calendar Day per Member for failure to timely notify the affected Member

Provider Network Management. $1,000 per provider, per Calendar Day

Provider Network Management. The RBHA's network management philosophy is based on the premise that all mandated and appropriate behavioral health and rehabilitation support services will be of high quality and provided in a culturally competent manner, in the least restrictive environments, accessible to all populations and sensitive to consumer choice. The Contractor's provider network shall be designed to meet the minimum network standards as described in Section B., Minimum Network Standards, and assure accessibility and availability of services provided by qualified professional staff. a. The Contractor shall allocate staff in the various administrative and clinical areas to: b. Maintain organizational, managerial and administrative systems and staff capable of fulfilling all Subcontract requirements; and c. Attend and actively participate in regularly scheduled meetings, workshops and committees for representation and input in the RBHA network management activities. d. The Contractor must maintain a continuum of care, which provides all Covered Services for the populations served. The continuum of care may be provided directly or through contractual arrangements with qualified providers (Subcontracted Providers). The Contractor shall:

Provider Network Management. $1,000 per provider, per Calendar Day 32. Failure to report notice of provider termination from participation in the PHP’s provider network (includes terminations initiated by the provider or by the PHP) to the Department or to the affected Members within the timeframes required by Section V.D.

Provider Network Management. $1,000 per occurrence

Provider Network Management. $100 per Calendar Day per Member for failure to timely notify the affected Member 33. Reserved. Reserved. 34. Failure to notify a provider of the network contracting decision within five (5) Business Days of verification of the provider’s status as a Medicaid Enrolled provider. $50 per Calendar Day per provider 35. Failure to provide covered services within the timely access, distance, and wait-time standards as described in Section V.D. 1. Provider Network (excludes Department approved exceptions to the network adequacy standards). $2,500 per month for failure to meet any of the listed standards, either individually or in combination 36. Failure to timely submit a PHP Network Data File that meets the Department’s specifications. $250 per Calendar Day

Provider Network Management. NCTracks is responsible for integrating the Provider Directory information to supply with a Consolidated Provider Directory to support PHP choice counseling and selection.

Provider Network Management. The RBHA's network management philosophy is based on the premise that all mandated and appropriate behavioral health and rehabilitation support services will be of high quality and provided in a culturally competent manner, in the least restrictive environments, accessible to all populations and sensitive to consumer choice. The Contractor's provider network shall be designed to meet the minimum network standards as described in Section B., Minimum Network Standards, and assure accessibility and availability of services provided by qualified professional staff. 1. The Contractor shall allocate staff in the various administrative and clinical areas to: a. Maintain organizational, managerial and administrative systems and staff capable of fulfilling all Subcontract requirements; and b. Attend and actively participate in regularly scheduled meetings, workshops and committees for representation and input in the RBHA network management activities. 2. The Contractor must maintain a continuum of care, which provides all Covered Services for the populations served. The continuum of care may be provided directly or through -------------------------------------------------------------------------------- [LOGO] Community Partnership SUBCONTRACT AGREEMENT of Southern Arizona COMPREHENSIVE SERVICE NETWORK Regional Behavioral The Providence Service Corporation Health Authority AMENDMENT #6 ------------------------------------------- CONTRACT NUMBER: A0108 FY 02/03 -------------------------------------------------------------------------------- contractual arrangements with qualified providers (Subcontracted Providers). The Contractor shall:

Provider Network Management. $100 per Calendar Day per Member for failure to timely notify the affected Member 33. Reserved. Reserved. 34. Failure to notify a provider of the network contracting decision within five (5) Business Days of verification of the provider’s status as a Medicaid Enrolled provider. $50 per Calendar Day per provider 35. Failure to provide covered services within the timely access, distance, and wait-time standards as described in Section V.D.1. Provider Network (excludes Department approved exceptions to the network adequacy standards). $2,500 per month for failure to meet any of the listed standards, either individually or in combination 36. Failure to timely submit a PHP Network Data File that meets the Department’s specifications. $250 per Calendar Day 37. Failure to maintain accurate provider directory information as required by Section V.D.2. Provider Network Management. $100 per confirmed incident 38. Failure to timely provide notice to the Department of capacity to serve the PHP’s expected enrollment as described in Section V.D.1. Provider Network. $2,500 per Calendar Day 39. Failure to submit quality measures including audited HEDIS results within the timeframes specified in Section V.E.1.