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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE II EXECUTIVE AND ADMINISTRATIVE OFFICERS
    OF THE COMMONWEALTH
  • CHAPTER 6D HEALTH POLICY COMMISSION
  • Section 12 Negotiation of network contracts by unregistered provider or provider organization prohibited

Section 12. (a) No provider or provider organization may negotiate network contracts with any carrier or third-party administrator except for a provider or provider organizations which are registered under this chapter and regulations promulgated under this chapter; provided, however, that nothing in this chapter shall require a provider or provider organization with a patient panel of 15,000 or fewer or which represents providers who collectively receive, less than $25,000,000 in annual net patient service revenue from carriers or third-party administrators to be registered if such provider or provider is not a risk-bearing provider organization.

(b) Nothing in this chapter shall require a carrier to negotiate a network contract with a registered provider organization or with a registered provider or provider organization for all providers that are part of, or represented by, a registered provider organization.