Service Standards

Provider agreements support patient service standards, which are consistent with TRICARE®, CMS, commercial, and state regulations.

Patients should be scheduled per these standards:

Communication between specialists and primary care providers

Effective communication between participating providers who supply specialty services and the Primary Care Providers who refer members for those services is essential to quality care. Timely receipt of consultation reports, diagnostic reports, operative reports, and discharge summaries improves continuity and enhances the quality of care provided. Please adhere to the following time frames:

• Routine Reports: 10 business days

• Urgent/Emergent: Preliminary report within 24 hours, via telephone, fax, or other means, with formal report within 10 business days

We encourage Primary Care Providers to request and expect reports from specialists who provide services to their patients within the time frames listed above.

New for 2027 | Refer In Network and Confirm Participation First

Participating Providers are expected to refer Martin's Point Health Care (MPHC) health plan Members to participating providers and facilities whenever appropriate network services are available. This includes all services and orders for specialty care, laboratory services, genetic testing, imaging, therapy, durable medical equipment, home health, and other health care services.

Before making a referral, Providers should confirm that the referred-to provider or facility participates in Member's specific plan network. Learn More

Communication between providers and members

All providers are free to communicate with Martin's Point Health Care members regarding treatment options and alternative medications, regardless of cost or benefit limitations.

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Martin's Point encourages our acute care institutional network providers to participate in the National Disaster Medical System (NDMS).

The NDMS is a federally coordinated system that augments the Nation's medical response capability. The overall purpose of the NDMS is to supplement an integrated National medical response capability for assisting State and local authorities in dealing with the medical impacts of major peacetime disasters and to provide support to the military and the Department of Veterans Affairs medical systems in caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts.

The National Response Framework utilizes the National Disaster Medical System (NDMS), as part of the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Services, to support Federal agencies in the management and coordination of the Federal medical response to major emergencies and federally declared disasters including:

• Natural Disasters

• Major Transportation Accidents

• Technological Disasters

• Acts of Terrorism including Weapons of Mass Destruction Events

For more information about becoming involved in NDMS, please visit aspr.hhs.gov

Participating Network Providers must not charge a ‘membership fee’ or ‘service fee’ to our members for services that are, in whole or in part, a covered Medicare/TRICARE service. 

Imposition of such charges is in direct conflict with CMS and TRICARE guidance and will result in termination or lack of entry into the network.

Reference: https://www.cms.gov/Medicare/Medicare-Contracting/ContractorLearningResources/Downloads/ja0421.pdf