Payment Rules for Direct-Contracting Providers

70.2.3 - Payment Rules for Direct-Contracting Providers (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) • The plan may establish payment rates for direct-contracting providers that are different than the rates established in the terms and conditions of payment for deemed providers. • Since the plan meets the access to services requirement by paying all providers at least the Original Medicare rates or higher, direct-contracting providers must also be paid at least the Original Medicare rates or higher. • The payment rates for direct-contracting providers must be established in the signed contract or agreement between the plan and the provider. • The payment rates can be provider-specific, and public disclosure of the rates is not required.