2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
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LegalOther Important ProvisionsThe following terms <strong>and</strong> conditions are deemed tobe incorporated into your agreement with<strong>Presbyterian</strong> Centennial Care:The agreement has been <strong>and</strong> shall beconsidered to be executed in accordance withall applicable federal <strong>and</strong> state laws,regulations, policies, procedures, <strong>and</strong> rulesThe agreement identifies the parties of thecontract <strong>and</strong> their legal basis of operation inthe State of New MexicoThe agreement includes procedures <strong>and</strong>specific criteria for terminating the subcontractThe agreement identifies the services,activities, <strong>and</strong> reporting responsibilities to beperformed by you <strong>and</strong> those servicesperformed under any other agreementThe agreement includes provisions describinghow services provided under the terms of theagreement are accessed by membersThe agreement includes the reimbursementrates <strong>and</strong> risk assumption, if applicable; youshall maintain all records relating to servicesprovided to members for a ten-year period<strong>and</strong> shall make all enrollee medical records orother service records available for the purposeof quality review conducted by the state, ortheir designated agents, both during <strong>and</strong> afterthe contract periodAll member information will be keptconfidential, as defined by federal <strong>and</strong> statelawAuthorized representatives of the state willhave reasonable access to facilities <strong>and</strong>records for financial <strong>and</strong> medical auditpurposes both during <strong>and</strong> after the contractperiodYou shall release to <strong>Presbyterian</strong> anyinformation necessary for <strong>Presbyterian</strong> toperform any of its obligations <strong>and</strong>acknowledge that <strong>Presbyterian</strong> shall bemonitoring your performance on an ongoingbasis <strong>and</strong> conducting formal periodic reviewsYou shall accept payment from <strong>Presbyterian</strong>as payment for all services included in thebenefit package, <strong>and</strong> you cannot requestpayment from the state for services performedunder your agreement with <strong>Presbyterian</strong>If your agreement with <strong>Presbyterian</strong> includesthe provision of primary care, then theprovisions for compliance with PCPrequirements delineated in the <strong>Presbyterian</strong>Centennial Care Agreement shall also applyto youYou are required to comply with all applicablestate <strong>and</strong> federal statutes, rules, <strong>and</strong>regulations<strong>Presbyterian</strong> may institute corrective actionplans if indicated, sanctions, <strong>and</strong>/ortermination for any violation of applicableHSD/MAD, state, or federal statutes, rules, orregulationsThe agreement with <strong>Presbyterian</strong> does notprohibit you or your subcontractors or anyone(with the exception of third-partyadministrators) from entering into a14-72014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
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