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Chapter 3- The Provider Network

Across
IN ORDER TO DO BUSINESS, PAYERS MUST MEET CREDENTIALING STANDARDS SET BY THE ___.
DEFINED GEOGRAPHIC AREA IN WHICH A PLAN PROVIDES ACCESS TO CARE (2 words)
RADIOLOGISTS, PATHOLOGISTS, ANESTHESIOLOGISTS, EMERGENCY MEDICINE PHYSICIANS ARE CONSIDERED ____PHYSICIANS. (2 words)
THE ___ CLAUSE REQUIRES THE PROVIDER TO TREAT PLAN MEMBERS NO DIFFERENTLY THAN THE PROVIDER TREATS ANY OTHER PATIENT
WHAT BOTH PAYERS AND PROVIDERS WANT WITH ALL PLANS IN THE AREA
PROVIDERS PREFER CONTRACTING BECAUSE THEY ARE ABLE TO OBTAIN A ____ PRICING WHEN IN A NEGOTIATING POSITION (HIGHER OR LOWER)
Down
PAYERS MUST MEET REGULATORY CREDENTIALING REQUIREMENTS SET BY THE ___.
TYPE OF MEDICAL GROUP THAT ARE LEGAL ENTITES (PARTNERSHIPS) WHERE PHYSICIANS SHARE OFFICE SPACE AND SUPPORT SERVICES (BILLING, SCHEDULING, ETC.)
THE RESPONSIBILITY OF CREDENTIALING TYPICALLY RESIDES WITH THE ____. (2 words)
NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS ARE CONSIDERED ____ MEDICAL PRACTITIONERS.
HOLDS DATA ABOUT MALPRACTICE AWARDS, SANCTIONS, HEALTHCARE FRAUD AND ABUSE FINDINGS FOR PHYSICIAN AND NONPHYSICIAN PROVIDERS. (2 words)
WHAT A HEALTH CONTRACT PLAN CAN DO TO A HEALTHCARE PROVIDING FACILITY IF SUSPICION OF BILLING PROBLEMS ARE OCCURING OR JUST FOR QUALITY ASSURANCE REASONS