Carrier/Vendor Contract Language

Before your client enters into a master services agreement with a Vendor, the agreement should be reviewed and, if necessary, negotiated to assure that the Health Plan has unlimited access to its data.  Following are key provisions to be included in Vendor master services agreements: 

1. The Health Plan shall have access to, at no cost, 3 years of historical data and 18 months of run-out data, and file feed distribution to the data recipient of your choice with no fees for either set up or monthly delivery. 
2. The file feeds provided by the Vendor shall include all of the data elements that are outlined in Vital Incite’s file request templates and included in the Advisor’s agreement with the Health Plan (the “Data”).  None of these data elements, especially medical provider charges and/or the Vendor’s “allowed amounts” shall be withheld by the Vendor. 
3. The Vendor shall begin to provide Health Plan-requested Data files no later than 20 business days after execution of the data sharing agreement with Health Plan’s third-party service provider. 
4. If there are data errors within the supplied files, corrected files will be delivered within 10 business days of the error being communicated to the data source. 
5. All legal documents associated with the Vendor’s master services agreement should be included as exhibits to the master services agreement and agreed to by the Health Plan in conjunction with entering into the Vendor’s master services agreement.  These legal documents should include any confidentiality and nondisclosure agreements that the Vendor will require the Health Plan’s third party services providers (such as Vital Incite) to execute, as well as Data Release Authorization Forms and Security Audit forms (collectively, “Ancillary Agreements”) – these should be reviewed by Vital Incite’s legal department prior to the Health Plan entering into a master services agreement with a Vendor.  If review and agreement to Ancillary Agreements is not possible, then at a minimum the Health Plan should assure that the master services agreement includes provisions that prohibit the Vendor from withholding from the Health Plan or its third party services providers any of the Data, or dictate how the Health Plan, or third party services providers on behalf of the Health Plan, uses the Data for internal purposes or within a benchmark database.   
6. The Vendor shall agree that it will employ its ‘best efforts’ to enter into any data sharing agreement with Health Plan’s third party service providers within five business days of the Health Plan’s request for such agreement to be entered into,  Such timetable should not be onerous on the Vendor, provided that the form data sharing agreement has been agreed to by the Health Plan and Vendor in connection with entering into a master services agreement (as described in point 5., above).  
7. The Vendor shall not restrict the Health Plan or its third-party services providers from including any Data in benchmark databases or from such Data remaining in data warehouses should the relationship with the Vendor terminate.  Additionally, all data provided can be shared with key representatives of the health plan, including your company’s leadership and its health benefits advisory firm. 
8. Vendors will use their ‘best efforts’ to improve the quality of data that it provides to the Health Plan so that such data better matches the carrier or vendor controls, as defined by the health plan.