RSA 420-C:3 · Reimbursement Agreements

420-C:3 Reimbursement Agreements. – Notwithstanding any other law to the contrary, a health care insurer may:

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I.

Enter into contracts or other agreements with preferred providers for the delivery of health care services to covered persons. Such contracts or agreements may:

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(a)

Establish the amount and method of payment to the preferred provider;

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(b)

Establish a procedure for the review and control of utilization of health care services; and

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(c)

Establish a mechanism for determining whether the health care services rendered are medically necessary.

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II.

Issue or administer policies or contracts which provide incentives for the covered person to use the health care services of preferred providers.

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III.

Issue or administer policies or contracts which provide benefits for health care services only if the services have been rendered by a preferred provider. Source. 1987, 112:1, eff. July 5, 1987.

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