The Health Care Service Provider Agreement serves as a crucial legal framework in the Philippine healthcare system, establishing formal relationships between healthcare providers and various contracting entities such as insurance companies, HMOs, or employers. This agreement is essential when healthcare providers wish to join networks, provide services to insured patients, or enter into corporate healthcare arrangements. It must comply with key Philippine legislation including the Universal Health Care Act (RA 11223), the National Health Insurance Act, and the Data Privacy Act. The document typically covers service standards, payment terms, quality metrics, and regulatory compliance requirements, while incorporating specific provisions for PhilHealth coordination and local healthcare delivery standards. It's particularly relevant in the context of the Philippines' push toward universal healthcare coverage and increased access to quality medical services.
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1. Parties: Identification of the contracting parties including full legal names, addresses, and registration details
2. Background: Context of the agreement and brief description of the parties' business relationship
3. Definitions: Detailed definitions of terms used throughout the agreement
4. Scope of Services: Detailed description of healthcare services to be provided, including specific medical procedures, treatments, and specialties covered
5. Provider Obligations: Healthcare provider's responsibilities, including quality standards, staffing requirements, and compliance with Philippine healthcare regulations
6. Accreditation and Licensing: Requirements for maintaining necessary licenses, permits, and accreditations under Philippine law
7. Quality Assurance: Standards of care, quality metrics, and monitoring procedures
8. Compensation and Billing: Payment terms, fee schedule, billing procedures, and claim submission requirements
9. Patient Rights and Responsibilities: Protection of patient rights and outline of patient responsibilities in accordance with Philippine healthcare laws
10. Records and Data Protection: Requirements for maintaining medical records and protecting patient data under the Data Privacy Act
11. Term and Termination: Duration of the agreement and conditions for termination
12. Insurance and Liability: Insurance requirements and allocation of liability between parties
13. Dispute Resolution: Procedures for resolving disputes, including mediation and arbitration processes
14. General Provisions: Standard contractual clauses including governing law, amendments, and notices
1. Emergency Services Protocol: Specific procedures for emergency services, required if provider offers emergency care
2. Teaching and Research: Terms for academic activities, required for teaching hospitals or research institutions
3. Electronic Health Records: Specific provisions for EHR systems and integration, if applicable
4. Specialty Care Services: Additional terms for specialized medical services, if offered
5. Network Participation: Terms for participation in healthcare networks or insurance panels, if applicable
6. Facility Requirements: Specific facility standards and equipment requirements, for facility-based services
7. Telehealth Services: Provisions for virtual healthcare services, if offered
8. International Patient Services: Additional requirements for treating international patients, if applicable
9. PhilHealth Coordination: Specific procedures for PhilHealth claims and coordination, if provider accepts PhilHealth
10. Sub-contractor Relations: Terms governing relationships with sub-contracted healthcare providers, if any
1. Schedule A - Fee Schedule: Detailed listing of fees for all covered services and procedures
2. Schedule B - Service Locations: List of approved facilities and service locations
3. Schedule C - Covered Services: Comprehensive list of medical services covered under the agreement
4. Schedule D - Quality Metrics: Specific quality standards and performance indicators
5. Schedule E - Required Documentation: List of required licenses, certifications, and documentation
6. Schedule F - Reporting Requirements: Details of required reports and reporting frequencies
7. Appendix 1 - Claims Submission Procedures: Detailed procedures for submitting and processing claims
8. Appendix 2 - Credentialing Requirements: Detailed provider credentialing and re-credentialing requirements
9. Appendix 3 - Emergency Protocols: Detailed emergency care protocols and procedures
10. Appendix 4 - Data Protection Protocols: Specific procedures for handling patient data and ensuring privacy
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