North Dakota Code 26.1-53.1-16 – Provider agreements
1. A discount plan organization must have a written provider agreement with all providers offering medical or ancillary services to the organization’s members. The written provider agreement may be entered directly with the provider or indirectly with a provider network to which the provider belongs.
Terms Used In North Dakota Code 26.1-53.1-16
- Contract: A legal written agreement that becomes binding when signed.
- following: when used by way of reference to a chapter or other part of a statute means the next preceding or next following chapter or other part. See North Dakota Code 1-01-49
- Organization: includes a foreign or domestic association, business trust, corporation, enterprise, estate, joint venture, limited liability company, limited liability partnership, limited partnership, partnership, trust, or any legal or commercial entity. See North Dakota Code 1-01-49
- written: include "typewriting" and "typewritten" and "printing" and "printed" except in the case of signatures and when the words are used by way of contrast to typewriting and printing. See North Dakota Code 1-01-37
2. A provider agreement between a discount plan organization and a provider must provide the following:
a. A list of the medical or ancillary services and products to be provided at a discount; b. The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the provider’s discounted rates; and
c. That the provider will not charge members more than the discounted rates.
3. A provider agreement between a discount plan organization and a provider network must require that the provider network have written agreements with the provider network’s providers which:
a. Contain the provisions described in subsection 2; b. Authorize the provider network to contract with the discount plan organization on behalf of the provider; and
c. Require the provider network to maintain an up-to-date list of the provider network’s contracted providers and to provide the list on a monthly basis to the discount plan organization.
4. A provider agreement between a discount plan organization and an entity that contracts with a provider network must require that the entity, in the entity’s contract with the provider network, require the provider network to have written agreements with the provider network’s providers which comply with subsection 3.
5. The discount plan organization shall maintain a copy of each active provider agreement into which the organization has entered.