Settlement Timeline

Key Dates to Track Health Plan Surplus
and Withhold Payments

 

 NEPHO Health Plan Settlement Timeframe:
Settlement Details:
  • The settlement for LCPN payor contracts is expected the January two years following the start of the contract performance year.
    • For example, our 2016 contract performance year is expected to settle January 2018.
  • The settlement for NEPHO contracts is expected by September following the contract performance year.
    • For example, our 2016 contract performance year is expected to settle in September 2017.There have been instances where the dollars returned are such that NEPHO determines it is efficient to wait to return the funds with the January settlement.
  • Several payors withhold funds from providers in the event of a loss in a risk contract. These withhold funds are returned from the payors to NEPHO, with their settlements.  NEPHO returns the withhold funds with settlement distribution, or earlier, if NEPHO determines it is prudent to do so.
    • The following contracts take a withhold: BCBS, Fallon, HPHC, and Tufts
Minimum Requirements:

NECoMG sets certain minimum requirements of its physicians, in order to participate in payor contract settlements.
Click here to be directed to the current year’s requirements.