The following provisions relate specifically to Medicare Advantage products and plans and are hereby incorporated into your participation agreement with care plus health plan, Inc.
References below to “Provider” are to be contracted provider of health care services as named in your provider participation agreement(“Agreement”) as well as all of Providers contracted and/or employed providers who provide health care services under the Agreement, as applicable. In the event of a conflict between the terms and conditions below and the terms of your
Agreement, the terms below control. All defined terms below shall have the meaning ascribed to them in the Agreement.
The following pertain solely to Medicare Advantage products and Plans
With respect to the “Duties and Responsibilities of Provider” section of your agreement, the following shall be incorporated as a supplement to the section:
Work Authorization Program
The Immigration Reform and Control Act of 1968 prohibit employers from knowingly hiring illegal workers. Provider shall only employ individuals who may legally work in the United States – either U.S citizens of foreign citizens who are authorized to work in the U.S. Provider shall use the U.S Department of Homeland Security’s E-Verify Employment Eligibility Verification system to verify the employment eligibility of:
All persons employed by the Provider, during the term of this Agreement, to perform employment duties within Florida, and
All persons(including subcontractors/downstream and/or employed providers)
With respect to the “Term and Termination” section of your Agreement the following shall be incorporated as a supplement to the section:
1. In accordance with Section 274A (e) of the Immigration and Nationality Act, the employment by any participating provider of unauthorized alien is a violation of this Act. If Provider knowingly employs unauthorized aliens, such violation shall be cause for unilateral termination of this Agreement.
2. Plan may suspend or terminate the participation of Provider or Provider’s affiliates providing services to plan members under this Agreement under circumstances including, but no limited to the
a) Termination, suspension, limitation, voluntary surrender or Restriction of professional license or other government Certification/licensure:
b) Conviction of a felony or any other criminal charge:
c) Any disciplinary action taken by the Drug Enforcement Agency (DFA)
d) Any other legal, government or other action or event which May metrically impair the ability to perform any duties or Obligation under this Agreement, or
As required by the Centers for Medicare & Medicaid(CMS), Plan shall notify any participating provider the right ot appeal Plan’s decision to suspend or terminate its participating agreement; provided, that the right to appeal is only applicable to certain individual health care practitioner(s), not the legal entity or vendor. Appeal rights are not applicable when provider fails to maintain professional licensure or any governmental authorization required to provide covered services under the terms and provisions set forth in this Agreement.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...