| It is NCPPO/HealthLink’s goal that enrollees have access to qualified, diverse care that offers an appropriate amount of choice. Toward meeting this goal, NCPPO/HealthLink has established network standards regarding provider availability and accessibility.
Specifically, the purposes of HealthLink’s participating provider availability and accessibility standards are as follows:
- To offer an adequate number and type of contracted or participating providers to meet the health needs of enrollees.
- To offer a network of participating providers that is geographically accessible to enrollees.
- To describe the participating provider availability and accessibility standards to state and/or federal regulators, accreditation agencies, benefit consultants, employers and other health care purchasers or prospective purchasers of NCPPO/HealthLink services.
Provider Network Adequacy Goals
The number of network providers of different types will vary from one service region/county to another. NCPPO/HealthLink will recruit and contract with sufficient providers of all types necessary to provide a full range of covered services.
In general, the provider network will:
- Be adequate in numbers and types of providers to meet the full range of health care service needs of the enrolled population.
- Include at least one community hospital; where one is available.
- Include at least 50 percent of the primary care physicians (PCPs) with active staff privileges on the medical staff of the contracted community hospital, within each county or multi-county region.
- Include within each county or multi-county region, enough primary care and specialty care physicians to provide enrollees a choice of physicians.
Contracting Criteria - Health Care Facilities, Ancillary Care Providers, and Other Provider Specialty Networks
Hospitals, other health care facilities, programs and ancillary care providers who/that desire to contract with NCPPO/HealthLink are required to meet the following contracting criteria, as applicable:
- Provider must be located within the approved service area (developed or in development as indicated in the corporate market plan and approved by management).
- Provider must provide health care services covered by benefit plans and/or benefit plans administered by affiliated insurance carriers.
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