The following statements are about some of the issues surrounding the contractual responsibilities of health plans. Select the answer choice containing the correct statement.
A) Typically, health plans are required to pay completed claims within 10 days of submission. 26
B) Health plans typically are prohibited from examining the financial soundness of a self-funded employer plan that relies on the health plan to pay providers for services received by the plan's members.
C) Patient delivery is one of the most significant factors that health plans consider when determining whether provider services should be reimbursed on a capitated or fee-for-service (FFS) basis.
D) Health plans require all providers to agree to an exclusive provider contract.

Question

Quizplus · Accepted Answer

Health plans consider factors like patient delivery when deciding between capitated or fee-for-service reimbursement models.

The Following Statements Are About Some of the Issues Surrounding