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The addendum defines the episode structure, including the episode period, acute and warranty periods, and treatment scope for index procedures such as total knee or hip replacement. It also details covered services, readmission handling, and clear exclusions for services not included in the negotiated bundled episode payment.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/health-plan-and-hospital-addendum-to-ppo-agreement-bundled-payment-program-terms/281778/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/health-plan-and-hospital-addendum-to-ppo-agreement-bundled-payment-program-terms/281778.png","ImageObject",442,249,{"name":88,"@type":89},"Lucas Martin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of the Health Plan and Hospital addendum to the PPO Agreement?","Question",{"text":109,"@type":110},"It establishes the terms under which the Provider participates in a Bundled Payment Program and how the negotiated bundled episode payment applies to covered hospital and post-acute services.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which services are included in the episode definition and bundled payment?",{"text":114,"@type":110},"Covered Services include related physician and anesthesia fees, preoperative and intra-operative services, postoperative surgeon-required services, follow-up visits, pain management, supplies (with stated exclusions), miscellaneous services, and other medically necessary inpatient and outpatient professional services under the program.",{"name":116,"@type":107,"acceptedAnswer":117},"How does the Episode Period work and how are readmissions handled?",{"text":118,"@type":110},"The Episode Period begins on the index procedure admission date and runs through the 90th day after the original admission. Readmissions starting within the Episode Period are included in the episode price even if they extend beyond 90 days, and the period is extended until discharge for covered complications.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},281778,1790435563,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":8,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":79,"preview_page_count":4},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","HEALTH PLAN and HOSPITAL ADDENDUM TO PPO AGREEMENT  \nTHIS BUNDLED PAYMENT ADDENDUM (this “Addendum”) is made and entered into by and between   , a (“Plan”), and   , a California   (“Provider”), as of   , 20  . (Plan and Provider are referred to herein individually as a “Party” and collectively as the “Parties”) .  \nThis Addendum sets forth the terms and conditions under which Provider will participate in a bundled payment arrangement (“Bundled Payment Program”) . Pursuant to the Bundled Payment Program, Provider has contracted with other providers to accept one case rate from Plan for specified services, which include both hospital and post-acute services.  \nThis Addendum effective date (“Bundled Payment Addendum Effective Date”) is listed below and binds this Addendum to the Parties’ [PPO Agreement] dated   (the “Agreement”) . This Addendum shall have a term coterminous with Agreement.  \nBundled Payment Addendum Effective Date:   .  \nA. INTRODUCTION  \nThe intent of the Parties is that the negotiated bundled episode payment should include all Covered Services provided to a Covered Person during the Episode Period for:  \n1. An Index Procedure of total knee or total hip replacement for patient with degenerative osteoarthritis;  \n2. Routine Care appropriate to the Index Procedure; and  \n3. Patient Complications arising during the stay for Index Procedure or during the Episode Warranty Period following the surgery, Included Readmissions and Revision Procedures performed during the Episode Period because of complications associated with the original procedure or for mechanical failure.  \nProvider and Plan may mutually agree to include an optional rehabilitation package for an additional negotiated fee.  \nB. DEFINITIONS  \n1.  Covered Services The following services are included in the episode definition and negotiated episode payment. They may not be separately billed by Provider when treating a Covered Person during the Episode Period.  \n􀁸 During the Episode Period, and for any included Readmission, Covered Services include:  \no All physicians, anesthesiologists, other attending and consulting physicians fees, beginning with the day of surgery;  \no Preoperative visits after the decision is made to operate;  \no Intra-operative services that are normally a usual and necessary part of a surgical procedure;  \no All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room;  \no Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;  \no Postsurgical pain management by the surgeon;  \no Supplies, except for those identified as exclusions;  \no Miscellaneous Services (items such as dressing changes; local incisional care; removal of operative pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes);  \no All other medically necessary services and supplies;  \no All inpatient and outpatient professional services;  \no All services provided by Provider or its contracting providers under the Bundled Payment Program.  \n􀁸 During the Episode Warranty Period (including Readmission), Covered Services include:  \no All Covered Services above: outpatient institutional and professional follow-up care, consultations, and related services, including but not limited to medical care, or similar services; and  \no All other related episode covered services will be included unless they are clearly caused by injury or disease other than the underlying disease for which the Index Procedure is being undertaken. For example, injuries due to an automobile accident or disease unrelated to the diagnosis of degenerative osteoarthritis (for example, primary care or specialis","cbCaia5cfxyjcw2m","https://ap.wps.com/l/cbCaia5cfxyjcw2m","pdf",512062,"English","# Introduction\n# Definitions\n## Covered Services\n## Episode Period","[{\"question\":\"What is the purpose of the Health Plan and Hospital addendum to the PPO Agreement?\",\"answer\":\"It establishes the terms under which the Provider participates in a Bundled Payment Program and how the negotiated bundled episode payment applies to covered hospital and post-acute services.\"},{\"question\":\"Which services are included in the episode definition and bundled payment?\",\"answer\":\"Covered Services include related physician and anesthesia fees, preoperative and intra-operative services, postoperative surgeon-required services, follow-up visits, pain management, supplies (with stated exclusions), miscellaneous services, and other medically necessary inpatient and outpatient professional services under the program.\"},{\"question\":\"How does the Episode Period work and how are readmissions handled?\",\"answer\":\"The Episode Period begins on the index procedure admission date and runs through the 90th day after the original admission. Readmissions starting within the Episode Period are included in the episode price even if they extend beyond 90 days, and the period is extended until discharge for covered complications.\"}]","Health Plan and Hospital Addendum to PPO Agreement - Bundled Payment Program Terms | PDF",1789568044]