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 health care providers who have not submitted claims for 1 year.
Inactivate any TIN under which there have been no claims submitted for 1 year.
When health care providers tell us of practitioners leaving a practice, we make multiple attempts to get documentation of that change.
We administratively terminate a health care provider if:
We get oral notice that a practitioner is no longer with a practice.
We make 3 attempts to obtain documentation confirming the practitioner’s departure, but do not receive the requested documentation.
The practitioner has not submitted claims under that practice’s TIN(s) for 6 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 Preferred Care Network 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 health 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.