The provider contract that Dr. Nick Mancini has with the Utopia Health Plan includes a clause that requires Utopia to reimburse Dr. Mancini on a fee-for-service (FFS) basis until 100 Utopia members have selected him as their primary care provider (PCP). At that time, Utopia will begin reimbursing him under a capitated arrangement. This clause in Dr. Mancini's provider contract is known as:
A) an antidisparagement clause
B) a low-enrollment guarantee clause
C) a retroactive enrollment changes clause
D) an eligibility guarantee clause

Question

Quizplus · Accepted Answer

The clause in Dr. Mancini's provider contract is known as a low-enrollment guarantee clause, which specifies that the provider will be reimbursed on a FFS basis until a certain number of members have selected him as their PCP, at which point the reimbursement will switch to a capitated arrangement.

The Provider Contract That Dr