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The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10% coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM). If Ionic’s actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of

The following statements are about workers' compensation provider networks. Select the answer choice containing the correct statement:  

Dr. Sylvia Cimer and Dr. Andrew Donne are obstetrician/gynecologists who participate in the same

provider network. Dr. Comer treats a large number of high-risk patients, whereas Dr. Donne’s

patients are generally healthy and rarely present complications. As a result, Dr. Comer typically

uses medical resources at a much higher rate than does Dr. Donne. In order to equitably compare

Dr. Comer’s performance with Dr. Donne’s performance, the health plan modified its evaluation to

account for differences in the providers’ patient populations and treatment protocols. The health

plan modified Dr. Comer’s and Dr. Donne’s performance data by means of 

In health plan pharmacy networks, service costs consist of two components: costs for services associated with dispensing prescription drugs and costs for cognitive services. Cognitive services typically include:

With respect to contractual provisions related to provider-patient communications, nonsolicitation clauses prohibit providers from