ATTACHMENT B
CONTRACTING PROVIDER COMPENSATION PROVISIONS
For Covered Services provided by Contracting Providers in accordance with the
terms and conditions of the Plan and the provisions of agreements through which HPHC
has arranged for the provision of Covered Services to Members, Purchaser shall provide
compensation in the amounts charged at the rate to which each Contracting Provider, or
an entity acting on the Contracting Provider's behalf, has agreed with HPHC or HPHC’s
designee. Purchaser understands that HPHC has a variety of agreements with
Contracting Providers relating to compensation arrangements for self-insured plans
administered by HPHC. These arrangements include, but are not limited to, withholds,
risk-sharing, vendor rebates/refunds, capitation, per diem paymenis, fee schedules and
DRGs. These arrangements are for the sole benefit of HPHC and Purchaser shall have
no interest in or claim on any of these arrangements, except to the extent that HPHC
has determined, in accordance with its reimbursement practices and procedures relating
to self-insured plans, to make such arrangements partiaily available to self-insured
plans. Purchaser acknowledges and agrees that HPHC has not represented or
guaranteed that Purchaser will receive the same reimbursements arrangement that
would apply to HPHC's insured business. Claims paid under the Plan shall be
determined and calculated on the basis of the foregoing rates of payment, for purposes
of Attachment D. Ail payments to providers shall be subject to the applicable
copayments and deductibles under the Plan.
Primary Care Providers, as defined in Attachment E, may be paid a monthly
management Fee for each member enrolled in his or her practice in addition to
compensation for Covered Services rendered. HPHC may amend the Managerient Fee
by thirty-days advance written notice to Purchaser.
Contracting Providers shall accept the above compensation as payment in full for .
Covered Services, except for applicable copayments and coinsurance.
FORM# PS_B01 i 05/17/2002
