19 Miss. Code. R. 3-14.07 - Intermediaries
A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section.
A. Intermediaries and participating providers
with whom they contract shall comply with all the applicable requirements of
Rule 14.06.
B. A health carrier's
statutory responsibility to monitor the offering of covered benefits to covered
persons shall not be delegated or assigned to the intermediary.
C. A health carrier shall have the right to
approve or disapprove participation status of a subcontracted provider in its
own or a contracted network for the purpose of delivering covered benefits to
the carrier's covered persons.
D. A
health carrier shall maintain copies of all intermediary health care
subcontracts at its principal place of business in the state or ensure that it
has access to all intermediary subcontracts. A health carrier shall make copies
of intermediary contracts available to the Commissioner upon demand.
E. If applicable, an intermediary shall
transmit utilization documentation and claims paid documentation to the health
carrier. The carrier shall monitor the timeliness and appropriateness of
payments made to providers and health care services received by covered
persons.
F. If applicable, an
intermediary shall maintain the books, records, financial information and
documentation of services provided to covered persons at its principal place of
business in the state and preserve them in a manner that facilitates regulatory
review by the Commissioner.
G. An
intermediary shall allow the Commissioner access to the intermediary's books,
records, financial information, and any documentation of services provided to
covered persons, as necessary to determine compliance with this
Regulation.
H. A health carrier
shall have the right, in the event of the intermediary's insolvency, to require
the assignment to the health carrier of the provisions of a provider's contract
addressing the provider's obligation to furnish covered services.
Notes
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