Ohio mandate calls for contract transparency

July 1, 2008

National Reports - A new Ohio mandate standardizes the credentialing process and promotes more contracting transparency and fairness in the managed care process.

NATIONAL REPORTS - A new Ohio mandate standardizes the credentialing process and promotes more contracting transparency and fairness in the managed care process.

"Physicians have had trouble in the past with access to fee schedules," Hackley says. "With the new law, physicians should have improved access to this information."

According to Stamer, many states have adopted specific statutory provisions or regulations governing contracting and claims processing requirements. For example, the Texas Insurance Code for many years under its prompt-pay and clean-claims rules has protected providers' right to receive notice of contract terms and changes, to get information about the calculation of benefits and other provisions overriding the use of certain types of contractual practices in provider contracts, and to receive provider credentialing rules.

"The Ohio law builds on this trend by implementing sweeping, detailed specific mandates governing contracts and their transparency," Stamer explains. "What's interesting is that [the law] provides an outline of the minimum required content that the contract must contain including specific and detailed mandates dictating that the contract include many specific provisions, as well as other requirements about rights the contract must expressly provide and prohibitions about the inclusion of certain other types of contractual provisions."

The new law is composed of three parts: transparency in contracting, fairness in contracting and standardized credentialing.