Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these five questions regarding referral requirements within managed care contracts during negotiations.
1. Do referral requirements, if any, properly explain the provider's obligations as they relate to other contracting and non-contracting facilities?
2. Does the contract specify which party is liable for payment of services on referral and payment of transportation, if applicable?
3. Does the contract permit subcontracting for services?
4. Does the contract permit a contracting provider to a non-contracting provider?
5. Does the contract in any way limit the provider from making the most appropriate referral?
1. Do referral requirements, if any, properly explain the provider's obligations as they relate to other contracting and non-contracting facilities?
2. Does the contract specify which party is liable for payment of services on referral and payment of transportation, if applicable?
3. Does the contract permit subcontracting for services?
4. Does the contract permit a contracting provider to a non-contracting provider?
5. Does the contract in any way limit the provider from making the most appropriate referral?
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