Contracts with Ancillary Providers

The plan may review copies of the hospitals' contracts with its ancillary providers to ensure the contracts meet regulatory requirements. Contracts must include language stating that:

• Members are not liable to the provider for any sums owed by the plan (hold-harmless language).
• Providers may not apply surcharges or any other charges, other than copayments, for covered services.
• Providers must maintain the confidentiality of member information and records.
• Providers must maintain timely, accurate and complete medical records.
• Providers must maintain records for a minimum of ten years.
• Providers must submit encounter data as required.
• Providers must comply with the medical policy, quality improvement (QI) and medical management policies of the plan.
• Providers must allow open provider-member communication regarding appropriate treatment alternatives.
• Providers must comply with applicable state, federal, and Medicare laws, regulations and reporting requirements.
• Contracts may not contain any incentive plan that includes payment as an inducement to deny, reduce, limit, or delay specific, medically necessary and appropriate services.
• Contracts must include accountability provisions.
• Contracts must allow access to medical records, to the extent permitted by law.