The CHPSO Participating Provider Agreement is broken down here in
three parts: Participating Provider Agreement, Exhibit 3.4 (BAA)
and Exhibit 8 (Out-of-State Fee Schedule).
Note: The Participating Provider Agreement and BAA must be
completed for all CHPSO member hospitals.
Participating Provider Agreement
This portion of the contract is the general agreement for CHPSO
and Providers. Includes Background, Definitions, General
Overview, CHPSO Responsibilities, Provider Responsibilities,
Responding to Requests for Information, Insurance and
Indemnification, Term and Termination, Miscellaneous, and Exhibit
1.1: Definitions Section of Patient Safety Act Regulations.
Note: This form requires Provider input on pages 1, 3, 6, and 7.
The BAA supplements the Participating Provider Agreement
as Exhibit 3.4. This addendum binds both entities as
Business Associates as given meaning by the Privacy Rule, the
Security Rule, and the HITECH Act.
Note: This form requires Provider input on pages 10, 15, and 16.