Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these three questions regarding obligations within managed care contracts during negotiations.
1. Do coordination-of-benefits provisions spell out the payor's payment obligations in instances where the payor is primary?
2. Do referral requirements, if any, properly explain the provider's obligations as they relate to other contracting and non-contracting facilities?
3. What are the provider's obligations if services are disrupted for any reason?
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1. Do coordination-of-benefits provisions spell out the payor's payment obligations in instances where the payor is primary?
2. Do referral requirements, if any, properly explain the provider's obligations as they relate to other contracting and non-contracting facilities?
3. What are the provider's obligations if services are disrupted for any reason?
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