Exhibit 10.143


 


 


EXPRESS
REFERRALS AMENDMENT

TO THE PACIFICARE OF CALIFORNIA

MEDICAL GROUP/IPA SERVICE AGREEMENT

(PROFESSIONAL CAPITATION)


 


This
Express Referrals Amendment to the Professional Capitation Medical Group/IPA
Services Agreement (the “Amendment”) is entered into effective as of
October 1, 2002 by and between PACIFICARE OF CALIFORNIA, a California
corporation (“PacifiCare”), and Sierra Medical Group (“Medical Group”), with
respect to the following facts:


 


RECITALS


 


A.     The parties have previously entered into that certain Professional
Capitation Medical Group/IPA Services Agreement dated July 1, 1999 (the
“Agreement”).


 


B.       The purpose of this Amendment is to add Express Referrals to the
Agreement.


 


NOW, THEREFORE, in consideration of the foregoing, the parties hereto
agree that the Agreement is hereby modified as specified below:


 


1.               ARTICLE 9, EXPRESS REFERRALS, shall be added as follows to the Agreement.


 


ARTICLE 9

EXPRESS REFERRALS


 


9.1           Additional Defined Terms.  The
capitalized terms used in this Article 9, which are not otherwise defined
herein, shall have the meanings ascribed to them in the Agreement.


 


9.1.1        Express
Referrals is the name of the
program established by PacifiCare for streamlined referrals of Medical Group
Members from Primary Care Physicians to specialists in Express Referrals
Specialties.


 


9.1.2        Express
Referrals Provider is any
PacifiCare Participating Provider that offers Express Referrals.


 


9.1.3        Express
Referrals Specialties
include, but are not limited to, the following specialties: Cardiology,
Dermatology, Endocrinology, Ear, Nose and Throat, Gastroenterology, General
Surgery, Hematology, Neurology, Obstetrics/Gynecology, Oncology, Ophthalmology,
Orthopedic Surgery, Podiatry, Routine Lab, Routine X-Ray, and Urology.  PacifiCare may modify the list of Express
Referrals Specialties at any time upon at least ninety (90) days’ prior written
notice to Medical Group.


 


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9.2           Duties of Medical Group


 


9.2.1        Establish
Streamlined Referral Process.  Medical Group shall establish a streamlined
referral process, through which any Primary Care Physician who deems that a
referral to a specialist in any Express Referrals Specialty for any Member is
necessary, may refer the Member to Medical Group’s Participating Providers
specializing in such Express Referrals Specialty without the prior
authorization of the Medical Group or the Medical Group’s utilization review
committee.  The Medical Group must, however,
continue to track all referrals.  If,
for any reason, Medical Group fails to maintain a streamlined referral process
which meets all of the requirements of Express Referrals, Medical Group shall
provide immediate written notice thereof to PacifiCare.  Medical Group’s failure to so notify PacifiCare
that it is no longer maintaining standards in compliance with Express Referrals
shall be a material breach of the Agreement, subjecting Medical Group to all of
the remedies contemplated thereby.


 


9.2.2        Access
to Records.  Medical Group will provide PacifiCare with
any and all necessary information including medical records, policies and
procedures, utilization review procedures and reports and other related
information necessary, in order for PacifiCare to verify that Medical Group has
a streamlined referral process which meets the requirements of Express
Referrals in a manner acceptable to PacifiCare.


 


9.2.3        Marketing
Activities.  Medical Group agrees to participate in
PacifiCare’s marketing activities to promote Express Referrals and to promote the
Medical Group as an Express Referrals Provider.


 


9.3           Duties of PacifiCare


 


9.3.1        Marketing
Activities.  PacifiCare shall engage in marketing
activities to promote Express Referrals, including identifying Medical Group as
an Express Referrals Provider in PacifiCare’s Provider Directory.


 


9.3.2        Determination
of Compliance by Medical Group.  PacifiCare reserves the right to determine
whether Medical Group is in compliance with the terms of this Article 9
and the requirements of Express Referrals. 
If PacifiCare determines that Medical Group is not properly maintaining
a streamlined referral process in compliance with the requirements of Express
Referrals, PacifiCare shall cease marketing Medical Group as an Express
Referrals Provider, and any future marketing of Medical Group as an Express
Referrals Provider will be at the sole discretion of PacifiCare.


 


9.4           Termination.  The
provisions of this Article 9 may be terminated


 


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by PacifiCare at any time upon ninety (90) days’ prior written notice
to Medical Group.


 


2.               AGREEMENT REMAINS IN FULL FORCE AND EFFECT. 
Except as specifically amended by this Amendment, the Agreement shall
continue in full force and effect.


 


IN WITNESS WHEREOF, the parties hereto have executed this Agreement in
Cypress, California.


 


	
   

  	
  PACIFICARE
  OF CALIFORNIA

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  Name:  Brian Jeffrey

  
	
   

  	
   

  
	
   

  	
  Title:   Vice President, Network Management

  
	
   

  	
   

  
	
   

  	
  Date:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  MEDICAL
  GROUP

  
	
   

  	
  SIERRA
  MEDICAL GROUP

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/
  Peter G. Goll

  	
   

  
	
   

  	
   

  
	
   

  	
  Name:

  	
  Peter G. Goll

  	
   

  
	
   

  	
   

  
	
   

  	
  Title:

  	
  Senior Vice President

  	
   

  
	
   

  	
   

  
	
   

  	
  Date:

  	
  9-18-02

  	
   

  
							



 


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