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TRH demo record · fictionalPayer Participation AgreementNotice period

Commercial Payer Participation Agreement

AGR-AE-001 · Aetna · Commercial Payer

$9.4M
Expected net / yr
Effective
2023-11-01
Expiration
2026-10-31
Notice date
2026-08-31
Term
35 mo
Total contract
$27.4M
Renewal
Auto-renew
Download contract (PDF)
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Contract document

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Parties

TRH demo record · fictional
Hospital (contracting party)
Texas Regional Hospital
Rural Texas · 50-bed PPS hospital · relationship owner C. Ford, Managed Care Director
Public company background · sourced
Payer counterparty
Aetna Inc. (a CVS Health company)
Health insurance (payer) · 151 Farmington Avenue, Hartford, CT 06156

Renewal timeline

  1. Effective date
    Agreement commencement.
    2023-11-01
    Past
  2. Amendment executed
    Annual fee-schedule update (+1.9% blended).
    2025-11-01
    Past
  3. Notice deadline
    Last day to give non-renewal notice before evergreen renewal.
    2026-08-31
    43d
  4. Expiration
    Auto-renews unless noticed.
    2026-10-31
    Upcoming

Extraction & review progress

Extracted — review
5 of 5 terms resolved · 0 verified100%
Approved 0Flagged 0Rejected 0Pending 5

Missing / contradictory terms

2
  • unverifiedExtraction status "Extracted — review": terms are surfaced with reduced confidence and flagged for review rather than presented as confirmed.
  • contradictionContracted obligation "Apply medical-necessity policy per Attachment 3" (Attachment 3) is currently breached in observed performance — a contradiction between the agreement and delivery that VERIFY surfaces rather than hides.

Risk flags

6
  • Notice window open
    Notice deadline in 43 days (2026-08-31). Auto-renews if missed.
    medium
  • Expiring soon
    Term expires in 104 days (2026-10-31).
    medium
  • 1 obligation breached
    Apply medical-necessity policy per Attachment 3
    high
  • 2 obligations at risk
    Pay per Attachment 1 fee schedule; Adjudicate clean claims within 21 days
    medium
  • Extraction not verified
    Term extraction status is "Extracted — review" — figures require human verification before reliance.
    low
  • 3 linked exceptions
    3 open spend/revenue exception(s) totaling recoverable/avoidable value against this counterparty.
    high

Extracted terms

Showing 5 of 5 terms
Expected net revenue (annual)Rates & feesmedium confidence
$9,400,000
§ Reimbursement · p.2
pending
TermDates & termmedium confidence
Evergreen — annual review
§8.1 Term · p.3
pending
Fee scheduleRates & feesmedium confidence
Attachment 1 (locked)
Attachment 1 · p.9
pending
Medical-necessity policySLAs & KPIsmedium confidence
Per Attachment 3
Attachment 3 · p.12
pending
Notice windowDates & termmedium confidence
60 days before annual review
§8.3 · p.3
pending

Rates, fees & escalators

Annual value
$9.4M
Term length
35 months
Total contract
$27.4M
  • Expected net revenue (annual): $9,400,000§ Reimbursement
  • Fee schedule: Attachment 1 (locked)Attachment 1
Escalators / value changes
  • 2025-11-01 — Annual fee-schedule update+1.9% blended

SLAs & KPIs

Financial (Yield) · 35%
Target: ≥ 98% expected yield · Actual: 96.7% yield · Expected-vs-paid model
Breached
Service (Adjudication) · 20%
Target: ≤ 21d clean pay · Actual: 25d avg · Remittance timing
At risk
Contract Compliance · 25%
Target: Fee schedule honored · Actual: 1 medical-necessity denial pattern · 835 variance model
At risk
Responsiveness · 12%
Target: Dispute ≤ 30d · Actual: 33d avg · Dispute log
At risk
Risk & Documentation · 8%
Target: Contract on file · Actual: Current · Managed-care file
Meeting

Obligations

0 reviewed
  • Apply medical-necessity policy per Attachment 3
    Attachment 3 · Per claim
    Breached
  • Pay per Attachment 1 fee schedule
    Attachment 1 · Per claim
    At risk
  • Adjudicate clean claims within 21 days
    §5.2 · Per claim
    At risk

Version history

  1. Original execution
    2023-11-01 — Commercial Payer Participation Agreement executed.
  2. Amendment 1CurrentViewing
    2025-11-01 — Annual fee-schedule update (+1.9% blended)

Viewing Amendment 1 — demo toggle only; archive-don't-delete keeps every prior version intact.

Linked spend / revenue exceptions

$122K
  • Denial variance
    Medical-necessity denial pattern vs. Attachment 3 policy.
    EX-2020 · In review
    $64,200
  • Underpayment
    Radiology fee-schedule variance on advanced imaging.
    EX-2021 · Open
    $41,500
  • SLA breach
    Adjudication timing exceeding 21-day window.
    EX-2022 · Open
    $16,000