New Claims System Update

Provider Manual
heartbeat_stet

12 PERFORMANCE AND TERMINATION

12.4 Notification to Members of Provider Termination

Health plans make a good faith effort to provide at least 30 calendar days written notice of a provider’s termination to all members who are seen on a regular basis by that provider before the termination effective date, regardless of the reason for the termination. Health plans may provide member notification in less than 30 days’ notice as a result of a provider’s death or exclusion from the federal health programs.

When a termination involves a PCP, all members who are patients of that PCP are notified of the termination by the health plan.