The provider named or identified is the party who receives payment under the provider contract to which the Disclosure Form applies. On line 1.B ., give the number of aggregated providers whose arrangements are being disclosed. Do not send lists of provider names. Line 1.C . Line 1.D .
Members are typically owners, partners, or employees of the physician group.
Question 2 identifies whether the incentive arrangement transfers any risk. A capitation payment is considered a transfer of risk for this question, even if the capitation is for services provided only by the contracting physician or physician group. A bonus for low utilization of referral services is considered to be risk transference. Question 3 identifies whether risk is transferred for referrals. A bonus for low utilization of hospital, specialist or other services is considered to be a risk for referral services.