Participating Provider Responsibilities

Below outlines important contract reminders for participating providers. Please note this is an overview and not intended to include all contractual provider obligations.

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Access to Care & Services

Provider will offer 24/7 telephone access to patients for their safety and protection, and will have procedures in place to respond to patients’ calls and requests after normal business hours.

Balance Billing

Provider will not balance bill the member beyond patient responsibility, such as co-payments, coinsurance, and deductibles.

Chargemaster Changes

Facilities (and other designated providers) will send The Alliance information regarding any modifications related to their charge master.

Claims Processing Errors

Provider will notify The Alliance in a timely manner of claim(s) processed or submitted incorrectly.

Claim Submission

Provider will submit claims according to regulations and in a timely manner to The Alliance.

Credentialing

Provider will comply with the requirements of The Alliance’s Provider Credentialing Program, including the timely completion of a credentialing application if requested.

Non-Discriminatory Treatment

Provider will provide services to all individuals in a prompt manner, consistent with professional, clinical, and ethical standards and without bias.

Provider Changes

Using the Provider Update Form, provider will notify The Alliance 30 business days prior to a change in the following:

  • Ownership (mergers, acquisitions, sale)
  • Tax identification numbers
  • Specialty designation of a practitioner
  • Practice locations
  • New practitioners
  • Other demographic information, including changes to individual providers
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