Physician Contracting -Understanding Physician Contracts
Ongoing participation in a health plan depends on providers meeting and maintaining the terms of their contract. We help health systems monitor provider contracts to be sure credentialing and other terms are met.
“So as far as the contracting piece goes, when it comes to enrollment, a contract isn’t just signed to say “hi, I’m a provider, I’d like to become participating with your plan.” “No problem! You’re in for life!” No. There’s terms and agreements that have to be met and maintained. So understanding the terms of those contracts is incredibly important. So far as that goes – the credentialing piece comes right hand in hand with it. The terms that contract are directly related to the credentialing as well. So you’re signing an agreement with a health plan that’s saying, I’m agreeing to your terms of my participation. So the maintenance of that become very, very key for the insurance carriers, because if it at any point in time they find out you’ve not met the terms of your contract, or you no longer have met the terms of your contract – you’ve got every opportunity to become an out of network provider and not participating… and that’s when the real trouble begins.”
Allyson Schiff, Senior Director, Growth & Strategy