Participating Provider Enrollments – ACO / PHO Relationships

This bulletin serves as a reminder of Meridian’s governance rules related to Participating (PAR) relationships, particularly as they pertain to Accountable Care Organizations (ACOs) and Physician Hospital Organizations (PHOs). This is not a new policy, but a clarification and reinforcement of existing standards following recent audits and data stabilization efforts.

A PAR relationship is defined by Taxpayer Identification Number (TIN). An individual TIN cannot participate in more than one Meridian relationship.

During recent auditing and stabilization of provider data on behalf of our relationship we want to gently remind our participating providers of the governance rules for participation in Meridian’s network:

• Direct Fee-for-Service Relationships:
  • If you have a direct-fee-for-service contract with Meridian, you may not also participate in a PHO or ACO relationship.
    • If Meridian’s provider data team identifies that a conflicting relationship exists (i.e., both a direct and a PHO/ACO arrangement), we will notify the PHO/ACO and request removal of your TIN from their participation rosters.
    • Please note: A provider cannot have both a direct contract and a PHO/ACO relationship.
• PHO/ACO-Only Participation
  • If you do not have a direct relationship with Meridian, and instead participate through a PHO or ACO, you may only participate in one PHO or ACO arrangement.
    • If our provider data team identifies that your TIN is associated with more than one PHO/ ACO, we will contact the PHO/ACO leads and request attestation regarding which relationship you wish to maintain.
    • Please note: A provider cannot have multiple PHO/ACO relationships under Meridian.

If you have any questions regarding your relationship with Meridian, please contact us via our Provider Relations Inquiry Form