62Q.733 DEFINITIONS.
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62Q.733 DEFINITIONS.
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Subdivision 1. Applicability.
For purposes of sections 62Q.732 to 62Q.739 , the following definitions apply.
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Subd. 2. Contract.
"Contract" means a written agreement between a health care provider and a health plan company to provide health care services.
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Subd. 3. Health care provider or provider.
"Health care provider" or "provider" means a physician, advanced practice registered nurse, physician assistant, chiropractor, dentist, podiatrist, or other provider as defined under section 62J.03 , other than hospitals, ambulatory surgical centers, or freestanding emergency rooms.
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Subd. 4. Health plan company.
(a)"Health plan company" means:
(1)a health maintenance organization operating under chapter 62D;
(2)a community integrated service network operating under chapter 62N;
(3)a preferred provider organization as defined in section 145.61, subdivision 4c ; or
(4)an insurance company licensed under chapter 60A, nonprofit health service corporation operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other entity that establishes, operates, or maintains a health benefit plan or network of health care providers where the providers have entered into a contract with the entity to provide health care services.
(b)This subdivision does not apply to a health plan company with respect to coverage described in section 62A.011, subdivision 3 , clauses
(1)to
(5)and
(7)to (12).
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Subd. 5. Fee schedule.
"Fee schedule" means the total expected financial compensation paid to a health care provider for providing a health care service as determined by the contract between the health plan company and the provider, inclusive of withhold amounts and any amount for which the patient or other third party may be obligated to pay under the contract.