| Name: Platinum Network A |
| Prefix: Standard Network/Provider/Plan Relationship |
| Effective Date: 05/21/2004 |
| Termination Date: |
| Auto Assign PCP:
Yes |
|
| Patient Acceptance: |
| New: Yes |
| Medicaid: Yes |
| Medicare: Yes |
|
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| Patient Counter: |
| Patient Counter Date: |
|
| Patient Restrictions: |
| Maximum Number: 99999 |
| Minimum Age: |
| Maximum Age: |
| Gender: Both |
|
| Limited Availability: |
| Risk Withhold Override%: N/A |
|
|
| Include in directory: Yes |
| Include Related Providers in Directory: Yes |
| Gender: Both |
| Provider In Area Zip Codes ID: |
| Description: |
| Capitation New Payee Retroactivity Code:Default to the Product value |
| Override months:Both |
|