The payer ensures that I know what products are covered by the contract.
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The member identification cards are easy to read and clear about the network being used.
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The payer provides sufficient information for provider payment denials. The appeals process is reasonable and decisions are timely and fair.
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The payer’s payment rates are adequate and not too heavily discounted.
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The payer’s payments are paid in a timely manner. Clean claims are paid within the appropriate 30-day time period specified by state law.
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The payer’s Physician Performance Data, ‘Tiered’ Product or Report Card data are accurate, valid, and used fairly and appropriately.
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The payer’s Explanation of Benefits provides sufficient detail to identify MNCare tax and when it is exempt.
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The payer’s Explanation of Benefits clearly explains member liability versus plan liability.
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The payer’s credentialing process is completed in a timely manner for any provider within 30 days.
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