Asuris and KCPHD Agreement - Laserfiche WebLink

Home Browse Search

ASURIS NORTHWEST HEALTH PARTICIPATING PROVIDER MEDICAL GROUP AGREEMENT PREFERRED PLAN PROVIDER NETWORK ADDENDUM EFFECTIVE DATE: This Addendum to the Participating Provider Medical Group Agreement, herein referred to as the "Medical Group Agreement", amends the Medical Group Agreement between Asuris Northwest Health (the "Company") and KITTITAS COUNTY HEALTH DEPT ("Medical Group"), to recognize additional provisions which apply to the Preferred Plan Provider Network, and to provide for the recognition of health care services, and for payment of benefits for health care services, provided to Preferred Members. Except as specifically amended herein, all terms and conditions of the Medical Group Agreement remain in effect. I. DEFINITIONS A. "Preferred Member" is any subscriber or enrolled dependent entitled to benefits under a Preferred Plan offered or administered by the Company or Payor, or any subscriber or enrolled dependent entitled to benefits under a Subscriber Agreement offered or administered by the Company or Payor that provides incentives for Members to seek services from Preferred Plan Providers and Participating Providers in the Company's Participating Provider Network. B. "Preferred Plan" is any Subscriber Agreement that provides a benefit incentive for subscribers or enrolled dependents to seek health care services from Preferred Plan Providers. C. "Preferred Plan Provider" is a Participating Provider in the Company's Preferred Plan Provider Network. D. "Preferred Plan Provider Network" is the collective group of hospitals, facilities, clinics, physicians and other health care professionals under contract with the Company through a Preferred Plan Provider Network Addendum. II. PROVISIONS A. Medical Group agrees to be a Preferred Plan Provider, participate in the Preferred Plan Provider Network and provide health care services to Preferred Members. B. The Company shall actively market Preferred Plans that provide incentives for Preferred Members to seek services from Preferred Plan Providers with the Company's Preferred Plan Provider Network. C. The Company shall also actively market a Subscriber Agreement that provides incentives for Members to seek services from Preferred Plan Providers and Participating Providers in the Company's Participating Provider Network. If Medical Group provides services for Members who are covered under such a Subscriber Agreement, the rates and terms associated with the Preferred Plan Provider Network, as well as the cost sharing amounts and terms in the Subscriber Agreement associated with the Preferred Plan Provider Network, shall be used to determine the reimbursement amount for Medical Group. Asuris Medical Standard MGA Preferred Plan Addendum A18816854AA Page 1 of 2