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Advisory: MultiPlan, Inc. is not contracted, affiliated with or engaged in any business relationship with American Trade Association, LLC (ATA), AmeriCare Health, Healthcare America, Pinnacle Health Solutions, Serve America Assurance, Ltd or Smart Data Solutions, LLC (SDS) of Tennessee. Member ID cards or plan documents bearing the MultPlan logo issued by
these organizations
• American Trade Association, Inc. / American Trade Association, LLC (ATA)
• AmeriCare Health • CEO Club Benefits • CEO Clubs, Inc. • Healthcare America • HealthFirst Plans / HealthEnroll • Pinnacle Health Solutions / Pinnacle Health Savings • Real Benefits Association • Serve America Assurance, Ltd. • Smart Data Solutions, LLC (SDS) • Viking Administrators, LLC • WebSmart Health are unauthorized. |
URAC Network Standards
The PHCS Network is accredited by URAC as a Health Network. Our MultiPlan Network Professional and MultiPlan Network Facility handbooks meet the updated URAC Network standards listed below:
N-NM7 - The organization has written agreements with all participating providers.
N-NM8 - The organization's written agreements with participating providers do not include:
- Any clauses or language that could restrict participating providers from discussing matters relevant
to consumers' health care; nor
- A definition of "medical necessity" that emphasizes cost/resource issues above clinical effectiveness.
N-NM9 - All new and revised written agreements (see N-NM7) executed by the organization include the following elements:
- A listing of all individuals or entities that are party to the written agreement;
- Conditions for participation as a participating provider;
- Obligations and responsibilities of the organization and the participating provider, including obligations, if any, for the participating provider to participate in the organization's management, complaint, or other programs;
- Events that may result in the reduction, suspension, or termination of network participation privileges;
- The specific circumstances under which the network may require access to consumers' medical records as part of the organization's programs or health benefits;
- Health care services to be provided and any related restrictions;
- Requirements for claims submission and any restrictions on billing of consumers;
- Participating provider payment methodology and fees;
- Mechanisms for dispute resolution by participating providers;
- Term of contract and procedures for terminating the contract;
- Requirements with respect to preserving the confidentiality of patient health information; and
- Prohibitions regarding discrimination against consumers.
N-NM10 - To the extent that a written agreement allows for sub-contracting with participating providers, the written agreement specifies that all sub-contracts will be subject to the terms of the written agreement as they pertain to the elements required in NM 8 and 9.