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2 Section I Definitions ................................................................................................................ 3 Accountable Care Organization (ACO) ................................................................................... 3 Claims Adjudication/Payment ................................................................................................. 3 Health Care Services .
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Vii FAQ
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No person or groups of persons may operate a health maintenance organization or issue a contract to an enrollee for membership in a comprehensive health services plan without first obtaining a certificate of authority from the commissioner.
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Contracted Service Provider means an individual or business that undertakes a contract or agreement with the City in order to perform a service on a continuing basis (e.g. Security Guard Services, Marriage Officiants, etc.).
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Contract Provider means any Person or any employee, agent or subcontractor of such Person who provides professional health care services under or pursuant to any contract with any Consolidated Party.
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A provider contract is a document that represents the business relationship between a provider and a payor. A provider can be either an individual physician or a provider organization with multiple doctors on staff.
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A contracted physician is one who sets his fees in ance with the terms of the agreement. In this case, you only make what is known as the co-payment, i.e. the difference between the amount refunded by the health insurance fund and the fees set under the agreement.
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A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They're known as “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.”
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These contracts establish a relationship between you and your patients for many aspects, such as: The type of care you will provide the patient. An outline of potential risks and benefits of a procedure. An agreement to be billed and pay for medical services.
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Definition of medical service contracts. . A medical service contract refers to a contract whereby the medical institution is authorized or duty-bound to perform medical treat- ment, epidemic prevention, health care or medical inspection for patients.
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