What Are Provisions?
Provisions are specific rules or requirements written into healthcare contracts. PriceMedic extracts these from the uploaded contract, organizes them, and makes them editable. Each provision includes:- What it says: Plain text requirement
- Where it came from: Page and paragraph reference
- Who it applies to: Provider, payer, or both
- Specific values: Dates, amounts, notice periods
- Priority: Which requirement takes precedence
- Source verification: Clear link back to the contract
Categories of Provisions
Key Dates and Terms
- Effective date
- Estimated effective date
- Term duration
- Renewal notice periods
- Auto renewal
Payment Terms
- Timely filing deadlines
- Processing and clean claim processing terms
- Reimbursement methodologies
- Fee schedules and timelines
Termination
- Termination for cause process and notice period
- Termination without cause process and notice period
Overpayment Recovery
- Recovery process
- Notification process and term
- Payment term
Underpayment Recovery
- Recovery process
- Notification process and term
- Payment term
Change of Control
- Notice period
- Notification process
Administrative Provisions
- Prior authorization requirements
- Claims submission and appeals
- Credentialing requirements
Clinical Requirements
- Quality measures
- Care management protocols
- Utilization review
- Documentation standards
Financial Terms
- Risk sharing and bonuses
- Penalty clauses
- Reconciliation
- Audit and compliance
These categories provide structure for organizing all extracted provisions and ensure consistency across contracts.