Managed Care Contracting & Provider Payment

What is a Network Access Agreement?

I was talking to Marla Durben Hirsch the other day, and she mentioned a warning issued by the California Medical Association to California physicians about a Network Access Agreement.  Apparently this national network is recontracting, so this is an issue that physicians in other states might want to watch. 

Quick Post: Connecticut Passes Law Prohibiting “Silent PPOs”

Connecticut joins approximately 12 other states restricting the selling of a physician’s discount.  The law requires any entity contracting with a physician, group, physician network, IPA organization or PHO to disclose the contracting entity’s intent to sell or lease contract rates, including providing a list of potential “customers” on request.  It requires all ID cards to provide a web address or toll free number access to the discount can be verified at the time of service.  It also requires the contracting entity’s right to sell that discount to terminate when the provider contract ends.   

Thank you to Marla Hirsh for passing this information along!

For a link to the bill, Click Pub. L. 08-126

Potential Remedy for Silent PPO Activity? Court Allows Damages to Georgia Physicians whose Discount Inappropriately Used

Two Georgia physicians sued Private Health Care Systems, a PPO provider network, claiming that PHCS injured them by inappropriately sharing their names and practice information with a company selling medical discount cards to the uninsured (“Capella”). The physicians claimed that their agreements with PHCS limited their participation to those PHCS plans or products whose members had insurance and PHCS misappropriated their identities for commercial gain when it made their names available to Capella for use by Capella card holders.