The Provider Contract That the Canyon Health Plan Has with Dr

question 107

Multiple Choice

The provider contract that the Canyon health plan has with Dr. Nicole Enberg specifies that she cannot sue or file any claims against a Canyon plan member for covered services, even if Canyon becomes insolvent or fails to meet its financial obligations. The contract also specifies that Canyon will compensate her under a typical discounted fee-for-service (DFFS) payment system. During its recredentialing of Dr. Enberg, Canyon developed a report that helped the health plan determine how well she met Canyon's standards. The report included cumulative performance data for Dr. Enberg and encompassed all measurable aspects of her performance. This report included such information as the number of hospital admissions Dr. Enberg had and the number of referrals she made outside of Canyon's provider network during a specified period. Canyon also used process measures, structural measures, and outcomes measures to evaluate Dr. Enberg's performance. The report that helped Canyon determine how well Dr. Enberg met the health plan's standards is known as:

• A) An encounter report
• B) An external standards report
• C) Aprovider profile
• D) An access to care report

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Definitions:

Dissatisfaction

A feeling of unhappiness or discontentment arising from unmet expectations or experiences.

Organizational Culture

A firm’s shared values, beliefs, traditions, philosophies, rules, and role models for behavior.