AARETE\agupta
1.3 KiB
1.3 KiB
| 1 | Filename | Agreement_Name (Contract Title) | PAYER NAME | Health Plan State | Affiliate (Y/N) | Credentialing Application Indicator | Term Clause | Evergreen, Fixed or Hard Term | Termination Date | Termination Upon Notice - Days | Termination With Cause - Days | Amend Contract Upon notice Flag (Y/N) | Timeframe to Object - Days | Assignments Clause (Y/N) | Contract Effective Date | IRS # | IRS_Name | NPI (10-digits) | NPI_NAME | PROV_GROUP_TIN_SIGNATORY | PROV_TIN_OTHER | PROV_NPI_OTHER | Notice to Provider Name | Notice to Provider Address | Sequestration Language | Sequestration Reductions, included [Medicare only] (Y/N) | PROV_TIN_OTHER.1 | PROV_NPI_OTHER.1 | Parent Agreement Code | Pages | page_num | Attachment/Exhibit | Line of Business | Provider Type | Provider Type - Level 2 | Service Type | Plan Type | Lesser of Logic Language, included (Y/N) | Lesser of Rate | Reimb. Methodology | Reimb. Methodology_short | If rate is % of Payer or MCR [STANDARD] | If rate is % of Payer or MCR [STANDARD]_Short | If rate is Flat Fee [STANDARD] | Default Term | Default Rate | Inclusion of essential RBRVS "Fee Source" Language (Y/N) | CDM Neutralization Language, included (Y/N) | Chargemaster Protection Language | Exclusions | Not to Exceed | Escalator or COLA (Y/N) | Escalator I, Eff. Date | IP/OP | IP - DSH/IME/UC, included (Y/N) | IP - Stoploss Catastrophic Threshold | Imputed Value |
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