A healthcare policy or regulation that allows healthcare providers to participate in a network or health plan if they meet certain criteria. Essentially, any qualified and willing provider is given the opportunity to be part of a network without being excluded based on arbitrary criteria.
A group of healthcare providers such as physicians, hospitals, and clinics that have contracted with a health insurance plan or managed care organization to provide services to covered individuals.
A fundamental concept associated with AWP laws, emphasizing the importance of fostering competition among healthcare providers. AWP aims to prevent anti-competitive practices, giving consumers a choice in selecting their healthcare providers.
A core principle of AWP laws, emphasizing the right of patients to choose any qualified healthcare provider for their medical services. This fosters a patient-centric approach and empowers individuals to make informed decisions about their healthcare.
Entities that coordinate and manage healthcare services for enrolled individuals. AWP laws may impact the relationship between MCOs and healthcare providers by promoting a more inclusive network.
The assurance that individuals have the ability to obtain necessary healthcare services from the provider of their choice. AWP laws seek to enhance access to care by reducing barriers and expanding the pool of available providers.
A critical consideration within AWP laws, emphasizing that the inclusion of providers should not compromise the overall quality of healthcare services. Regulatory frameworks often require participating providers to meet specific quality standards.
A term referring to the varied state-level policies and regulations governing AWP laws. States may have different approaches and requirements, leading to a diverse regulatory landscape across the country.
Legal safeguards within AWP laws preventing health plans or MCOs from directing or influencing patients to choose specific providers based on financial incentives. This helps maintain the autonomy of patients in their provider selection.
The rates at which healthcare providers are compensated for the services they render. AWP laws may impact reimbursement negotiations between providers and payers, influencing the financial aspects of healthcare delivery.
The process by which healthcare providers are evaluated and verified for their qualifications, experience, and adherence to quality standards before being allowed to participate in a provider network. AWP laws may have implications for this credentialing process.
A measure ensuring that a health plan’s provider network is sufficient to meet the healthcare needs of its enrolled population. AWP laws may influence how states assess and regulate network adequacy to guarantee that patients have reasonable access to care.