PRIMARY CARE PHYSICIAN PROVIDER AGREEMENT
WELLCARE OF FLORIDA, INC.
Renaissance Health Systems of Florida, Inc
THIS PRIMARY CARE PHYSICIAN PROVIDER AGREEMENT Agreement”) is made and entered
into this 7th day of November, 2001, (the “Effective Date”) and between WellCare of Florida, Inc. (“Health
Plan”), and Renaissance Health Systems Florida, Inc (“Provider”).
A. Whereas, Health Plan operates a State licensed Health Maintenance Organization; and either contracts
with or has applied to the Florida Agency for Health Care Administration and/or the Centers for
Medicare and Medicaid Services to offer benefit plans in Provider’s service area; and
B. Whereas, Provider is a duly licensed _____________ and is capable and willing to provide Covered
Services to Health Plan Members; and
C. Whereas, the parties desire to set forth their agreement concerning the provision of medical services to
Health Plan Members by Provider.
NOW, THEREFORE , in consideration of the premises and mutual covenants herein contained and other good
and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereby agree
Article I: Definitions
Authorization or Authorized . A determination which sometimes is required by the Health Plan or its
delegated entities that Covered Services are or were Medically Necessary and meet the standards and criteria
for payment according to the Health Plan’s established QI/UM Program. Authorization is not an assurance or
waiver that the eligibility of a Member is valid, and therefore not a guarantee of reimbursement.
Commercial Policy . A policy which sets forth the terms and conditions governing the relationship
between Health Plan and policy holder for the provision of Covered Services to Commercial Members.
Commercial Members are those individuals and groups insured by the Health Plan under a group or individual