Participating Provider Responsibilities

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

Access to care and services: The Alliance requires participating providers offer 24-hour/7 days per week telephone access to patients for their safety and protection.  Providers must 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.

Charge Master 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 timely of claim(s) processed or submitted incorrectly.

Claim Submission. Provider will submit claims according to regulations. Provider will submit claims timely to The Alliance.

Credentialing: Providers shall comply with the requirements of the Provider Credentialing Program maintained by The Alliance, including the timely completion of a credentialing application if requested.

Nondiscriminatory Treatment. Provider agrees to 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, notify The Alliance thirty (30) business days prior to a change in the following:

  • Ownership changes (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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