My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
First CHoice Agreement
>
Meetings
>
2018
>
05. May
>
2018-05-15 10:00 AM - Commissioners' Agenda
>
First CHoice Agreement
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/14/2018 12:18:38 PM
Creation date
5/14/2018 12:17:07 PM
Metadata
Fields
Template:
Meeting
Date
5/15/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
e
Item
Request to Approve a Preferred Provider/Group Agreement with First Choice Health Network
Order
5
Placement
Consent Agenda
Row ID
44613
Type
Agreement
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
37
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
with the law from advocating on behalf of a Participant with FCHN or a Payor. Nothing in this Agreement shall be <br />construed to authorize Provider to bind FCHN or its Payors to pay for any services. <br />FCHN may not and FCHN shall require all Payors contracting with it to not preclude or discourage Participants or <br />those paying for their coverage from discussing the comparative merits of different health carriers with their <br />Providers. This prohibition specifically includes prohibiting or limiting Providers participating in those discussions <br />even if critical of FCHN or its Payors. <br />3.7 Provider's Right to Report to Federal or State Authorities <br />FCHN shall not and FCHN shall require all Payors contracting with it to not penalize a Participating Provider <br />because the Provider, in good faith, reports to State or Federal authorities any act or practice by FCHN or its <br />Payors that jeopardizes patient health or welfare, or that may violate State or Federal law. <br />3.8 Participants' Contracting for Services Outside of Benefit Plan <br />Notwithstanding any other provision of law, FCHN may not prohibit directly or indirectly Participants from freely <br />contracting at any time to obtain any health care services outside FCHN on any terms or conditions the <br />Participants choose. Nothing in this provision shall be construed to bind FCHN Payors to pay for any services <br />delivered outside of a Participant's Benefit Plan. <br />FCHN expressly disclaims any and all responsibility on the part of FCHN and Payors for (i) the delivery of health <br />care services pursuant to any contract to which FCHN or the Payor respectively is not a party or which are outside <br />the terms of any Benefit Plan, and (ii) the payment of charges for such services. Provider agrees to look only to <br />the Participant for payment of charges for such services. <br />3.9 ID Cards <br />FCHN shall require its Payors to provide each Participant with a Benefit Plan membership identification card <br />displaying the First Choice Health logo, the Participant's name and identifier, group name and/or number, <br />telephone number to confirm eligibility and benefit verification, any applicable Co -payment due at time of service, <br />and utilization management vendor name and telephone number to confirm necessary pre -authorization for <br />services. <br />Provider is obligated to accept any individual as a Participant: <br />a) when the First Choice Health logo appears on the individual's membership identification card, <br />b) where the Payor is identified as accessing the FCHN PPO Network on the FCHN website or Payor listing, <br />and/or <br />c) in cases where the Participant of a FCHN Payor has an Emergency Medical Condition and/or requires <br />Urgent Services and is traveling or out -of -area and does not have a FCHN logo. <br />3.10 List of Payors <br />FCHN shall provide Provider with access to a list of Payors, including employer groups, at the time of entering into <br />this Agreement. This list shall be maintained and posted on the FCHN web site. <br />3.11 Explanation of Payment/Remittance Advice <br />FCHN shallrequire Payors to produce an Explanation of Payment (EOP) or Remittance Advice (RA) during the <br />claim adjudication process which must, at a minimum, identify: FCHN, total billed charges, allowed amount in <br />accordance with FCHN fee schedules, the amount the Payor is responsible to pay, the amount the Participant is <br />responsible to pay, and an explanation for non-payment of a particular code or service. Provider may refuse to <br />give the Payor the benefit of FCHN's fee schedule if the EOP/RA does not display minimum data elements and <br />the FCHN names and/or logo. <br />4. CLAIMS SUBMISSION AND PAYMENT <br />4.1 Claims Submission <br />FCHN-PRO-042016 <br />
The URL can be used to link to this page
Your browser does not support the video tag.