Network Management

Most health plan contracts provide an outline of the criteria that a healthcare service must meet in order to be considered "medically necessary." Typically, in...

When the Rialto Health Plan determines which of the emergency services received by its plan members should be covered by the health plan, it is guided by a stan...

The provider contract between the Ocelot Health Plan and Dr. Enos Zorn, one of the health plan's participating providers, is a brief contract which includes, by...

A provider contract describes the responsibilities of each party to the contract. These responsibilities can be divided into provider responsibilities, health p...

The Medea Clinic is a network provider for Delphic Healthcare. Delphic transferred the contract it held with Medea to the Elixir HMO, an entity that was not par...