It is the NCPPO and HealthLink network program's goal that enrollees have access to qualified, diverse care that offers an appropriate amount
of choice. Toward meeting this goal, NCPPO and HealthLink has established network standards
regarding provider availability and accessibility.
Specifically, the purposes of 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 and HealthLink services.
Provider Network Adequacy Goals
The number of network providers of different types will vary from
one service region/county to another. The NCPPO and HealthLink network program 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 and 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.