Membership Requirements

Membership in the Saint Alphonsus Health Alliance (Alliance) is a privilege which will be extended only to professionally competent practitioners who continuously meet the qualifications and responsibilities set forth in these Policies and according to the needs of the managed care network and community as determined in the sole discretion of The Alliance.

To become a participating provider for the Alliance, please send a completed questionaire to SAHAcontracting@saintalphonsus.org. Expectations for Alliance participating providers can be found here.

Minimum Qualifications for Saint Alphonsus Health Alliance Membership

The following are the minimum standards for acceptance into the Saint Alphonsus Health Alliance:

• Hold a valid license to practice as a physician, dentist, independent practitioner in a State in which The Alliance operates;
• Possess relevant education, training, experience and good judgment;
• Hold current and valid federal and state controlled substance certificates (if applicable to practice/specialty);
• Be free of any pending or previous disciplinary actions by a state or federal licensing board or regulatory agency or other healthcare organization;
• Be free of any restrictions to practice by a state or federal licensing board or regulatory agency or other healthcare organization
• Be free of criminal activity which demonstrates poor judgment related to the performance of their duties;
• Demonstrate their good reputation and character and their ability to work harmoniously with others;
• Possess current professional liability insurance with a minimum coverage of $1,000,000 per occurrence and $3,000,000 aggregate.

Participation Agreement

Applicants must have a current and valid Participation Agreement on file with the Saint Alphonsus Health Alliance. Members must continuously be in compliance with the provisions set forth in the Participation Agreement and be in good standing to participate in the network.

Non-Discrimination

The Alliance will not unlawfully discriminate in granting membership on the basis of ancestry, race, gender, national origin, faith, age or disability.

Code of Conduct

Saint Alphonsus Health Alliance (Alliance) members will:

• Continuously work to improve quality of patient care and services; to appropriately disseminate information and practice and care information;
• Communicate with providers and patients in an open, honest, direct and respectful manner;
• Participate in performance improvement and peer review activities;
• Actively participate in clinical integration program initiatives, and measures adopted by The Alliance;
• Comply with all applicable terms, policies, protocols, rules and regulations of The Alliance;
• Commit to standards of access whereby Participating Members, subject to applicable law, share claims data on patients covered by The Alliance contracts, honor in-network referrals, and participate in The Alliance activities in areas where The Alliance contracts;
• Maintain appropriate technological protocols at practice sites;
• Participate, within reason, in The Alliance’s quality assurance, utilization review and risk management programs and serve on such committees as may be requested by The Alliance from time to time;
• Participate, within reason, in on-going quality assurance monitoring activities, such as audits;
• Comply with the clinical protocols, criteria, and procedures developed by The Alliance to assure the consistency and quality of all professional services provided under the Contracts with health plans, third party payers, and governmental programs;
• Ensure that all services provided in connection with membership in The Alliance are at all times rendered in a competent and professional manner, consistent with the continuous quality improvement standards of The Alliance as agreed upon by the The Saint Alphonsus Health Alliance;
• Comply with all applicable laws, rules and regulations. Appropriately maintains confidentiality of patient information.