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Physician ’ s Role as a Contracted Provider ____________________________________________________
The physician plays a vital role with our organization by providing and overseeing a patient ’ s care . A physician contracted with Hometown Health may participate as :
• A PCP designated to manage the care of a given patient ;
• A specialty care physician , or specialist , called upon when the patient requires specialized care . o Please see the Prior Authorization and Utilization Management Program Requirements section of this manual for information regarding obtaining authorizations .
Physicians and physician extenders , like physician assistants , nurse practitioners , and behavioral health interns , are expected to comply with credentialing and recredentialing requirements as established by Hometown Health in relation to URAC standards . Physicians and physician extenders are attached to a specific contracted TIN for billing and payment . Providers and / or subcontractors such as physicians and physician extenders are required to comply with all terms and conditions of the current contracted agreement . All members of a physician practice that is billing under a TIN must be credentialed and services rendered by that physician or physician extender must be billed under the NPI of the servicing provider , not the TIN owner to meet Hometown Health and CMS guidelines . Failure of a provider to bill correctly could lead to a fraud , waste , and abuse investigation and termination from the Hometown Health network .
Because providers are paid according to a contracted TIN , providers and extenders who leave a contracted provider arrangement are considered to have been termed from the provider network . Any request for a new contract for that provider will be subject to review according to Hometown Health policies and procedures .
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