 |
 |
PHCS is accredited by URAC for our Health Network and Health Utilization Management. To
maintain that compliance, our Preferred Professional
and Facility Handbooks meet the updated URAC
Network standards listed below:
N-NM9 - The organization has written agreements with all participating providers.
N-NM11 - All new written agreements (see N-NM9) executed by the organization include
the following elements:
- A listing of all individuals or entities that are party to the written agreement;
- Definitions for terms used in the agreement;
- Conditions for participation as a participating provider;
- Obligations and responsibilities of the organization and the participating provider, including any obligations for the participating provider to participate in the organization's management, complaint, or other programs;
- Events that may result in the reduction, suspension, or termination of network participating privileges;
- The specific circumstances under which the Network may require access to consumers' medical records as part of the organization's programs or health benefits;
- Health care services to be provided and any related restrictions;
- Requirements for claims submission and any restrictions on billing of consumers;
- Participating provider payment methodology and fees;
- Mechanisms for dispute resolution by participating providers;
- Term of contract and procedures for terminating the contract;
- Requirements with respect to preserving the confidentiality of patient health information; and
- Prohibitions regarding discrimination against consumers.
N-NM12 - All revised written agreements comply with standard N-NM11.
For all recent Preferred Professional and Facility Handbook revisions, please refer to our
Provider Handbook Updates section. If you have
any questions about these handbook revisions, please contact Member and Provider Services at
(800) 950-7040.
|
