A Group Of Providers Having Participation Agreements

The ACA uses definitions of exchange products that probably do not meet the definitions contained in the security management agreements of many suppliers. Some agreements use. B the term „health plan“ as an organization of administered care. This can be confusing because the ACA uses the term „health plan“ and „qualified health plan“ as a „benefit plan“ and „health insurance provider“ as a management organization. To avoid confusion with the ACA, this health reform warning uses the term „managed care organization“ instead of „health plan.“ Fourth, many agreements list the performance plans for which they apply in a separate schedule. These schedules can be very general (list all „commercial“ or „Medicare Advantage“ products) or very specific (product by name designation) and must be carefully checked. [2] Small businesses have access to a small business health options program (called the SHOP Exchange by the ACA). Shop exchanges will help small, qualified employers enroll their employees in qualified health plans in the small group market in their state. A state can offer both an exchange and a SHOP Exchange through an exchange. Further discussions on the exchange of the BOUTIQUE will be discussed in a future warning on health system reform. By comparison, in Massachusetts, there is a commercial health insurance exchange called „Health Connector.“ Many managed care organizations in Massachusetts have had to modify some supplier agreements when offering exchange products to specifically target these products and tariffs. Hospitals, physicians and other health care providers should begin reviewing their merchant-managed care participation agreements to determine if they are candidates for product exchange when implemented, particularly if the duration of the agreement is still green or ends after January 1, 2014.

[3] Registration in exchange products begins in October 2013, but health plans will likely submit their applications to offer products on these exchanges, including a list of their supplier networks for these exchange products, starting in early 2013.

This entry was posted in Allgemein. Bookmark the permalink.

Comments are closed.