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Participating Provider Agreement
"I need a Participating Provider Agreement for my multi-specialty clinic in Manila to join a national HMO network, with specific provisions for telemedicine services and electronic health records integration, to be effective from March 1, 2025."
1. Parties: Identification of the contracting parties - the healthcare network/payor and the healthcare provider
2. Background: Context of the agreement and brief description of the parties' business activities
3. Definitions: Definitions of key terms used throughout the agreement
4. Scope of Services: Detailed description of medical services to be provided, including covered procedures and treatments
5. Provider Obligations: Key responsibilities of the healthcare provider, including quality standards, licensing requirements, and service levels
6. Payor Obligations: Responsibilities of the payor/network, including patient referrals and support services
7. Compensation and Billing: Payment terms, fee schedule, claims submission process, and reimbursement procedures
8. Quality Assurance: Quality standards, performance metrics, and monitoring procedures
9. Compliance Requirements: Regulatory compliance obligations, including licensing, accreditation, and reporting requirements
10. Records and Reporting: Requirements for maintaining medical records, reporting obligations, and documentation standards
11. Confidentiality and Data Protection: Obligations regarding patient privacy, data security, and compliance with privacy laws
12. Term and Termination: Duration of the agreement, renewal provisions, and termination rights
13. Liability and Indemnification: Allocation of risks, insurance requirements, and indemnification obligations
14. Dispute Resolution: Procedures for resolving disputes, including mediation and arbitration provisions
15. General Provisions: Standard contractual provisions including notices, amendments, and governing law
1. Exclusivity: Terms regarding exclusive arrangements, if the provider agrees to work solely with the network
2. Marketing and Branding: Guidelines for use of names, logos, and marketing materials, if joint marketing is contemplated
3. Electronic Health Records: Specific provisions for EHR systems and integration, if electronic records are used
4. Telehealth Services: Requirements and procedures for providing telehealth services, if applicable
5. Training Requirements: Specific training obligations for provider staff, if required by the network
6. Emergency Services Protocol: Special procedures for emergency services, if the provider offers emergency care
7. Pharmacy Services: Specific requirements for prescription drugs and pharmacy services, if provided
8. Research and Clinical Trials: Provisions for participation in research or clinical trials, if relevant
1. Schedule A - Fee Schedule: Detailed list of covered services and corresponding payment rates
2. Schedule B - Quality Metrics: Specific performance indicators and quality standards to be maintained
3. Schedule C - Required Insurance Coverage: Details of mandatory insurance coverage and minimum limits
4. Schedule D - Credentialing Requirements: List of required credentials, certifications, and licensing requirements
5. Schedule E - Service Locations: List of approved facility locations where services can be provided
6. Schedule F - Claims Submission Procedures: Detailed procedures for submitting and processing claims
7. Appendix 1 - Required Forms: Standard forms for claims, referrals, and other administrative processes
8. Appendix 2 - Network Policies: Key network policies and procedures that providers must follow
Authors
Healthcare
Insurance
Medical Services
Healthcare Technology
Pharmaceuticals
Diagnostics
Ambulatory Care
Primary Care
Specialty Care
Healthcare Administration
Legal
Compliance
Provider Relations
Network Management
Operations
Quality Assurance
Claims Processing
Risk Management
Medical Affairs
Contract Administration
Healthcare Services
Business Development
Healthcare Network Manager
Provider Relations Director
Medical Director
Compliance Officer
Healthcare Administrator
Contract Manager
Legal Counsel
Claims Processing Manager
Quality Assurance Manager
Operations Director
Healthcare Facility Administrator
Risk Management Officer
Business Development Manager
Medical Services Coordinator
Network Development Manager
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