2006 Ohio Revised Code - 1753.07. Furnishing of information and documents to provider.

§ 1753.07. Furnishing of information and documents to provider.
 

(A)  Prior to entering into a participation contract with a provider under section 1751.13 of the Revised Code, a health insuring corporation shall disclose basic information regarding its programs and procedures to the provider, upon the provider's request. The information shall include all of the following: 

(1) How a participating provider is reimbursed for the participating provider's services, including the range and structure of any financial risk sharing arrangements, a description of any incentive plans, and, if reimbursed according to a type of fee-for-service arrangement, the level of reimbursement for the participating provider's services; 

(2) How referrals to other participating providers or to nonparticipating providers are made; 

(3) The availability of dispute resolution procedures and the potential for cost to be incurred; 

(4) How a participating provider's name and address will be used in marketing materials. 

(B)  A health insuring corporation shall provide all of the following to a participating provider: 

(1) Any material incorporated by reference into the participation contract, that is not otherwise available as a public record, if such material affects the participating provider; 

(2) Administrative manuals related to provider participation, if any; 

(3) A signed and dated copy of the final participation contract. 
 

HISTORY: 147 v H 361. Eff 10-1-98.
 

The effective date is set by section 3 of HB 361.