Administrative Terminations for Inactivity
Up-to-date directories are a critical element of providing our members with the information they need to take care of their health. To offer more exact and up-to-date directories, we:
- Administratively terminate Agreements for care providers who have not submitted claims for one year, and
- Inactivate any tax identification number (TIN) under which there have been no claims submitted for one year.
When care providers tell us of practitioners leaving a practice, we make multiple attempts to get documentation of that change.
We administratively terminate a care provider if:
- We get oral notice that a practitioner is no longer with a practice, and
- We make three attempts to obtain documentation confirming the practitioner’s departure, but do not receive the requested documentation, and
- The practitioner has not submitted claims under that practice’s TIN(s) for six months prior to our receipt of oral notice the practitioner left the practice, or the effective date of departure provided to us, whichever is sooner. This does not apply to Medica HealthCare and Preferred Care Partners.
Continuity of Care Following Termination of Your Participation
If your Agreement ends for any reason, you may be required to help our members find another participating care provider. You may need to provide services at our contracted rate during the continuation period, per your Agreement and any applicable laws. We are ready to help you and our members with the transition. We tell affected members at least 30 calendar days prior to the effective date of your participation termination, or as required under applicable laws.