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TRH demo record · fictionalPayer Participation AgreementActive

Statewide Blue Plan Participation Agreement

AGR-BX-001 · Blue Cross and Blue Shield of Texas · Commercial Payer

$18.9M
Expected net / yr
Effective
2022-04-01
Expiration
2027-03-31
Notice date
2026-12-31
Term
59 mo
Total contract
$92.9M
Renewal
Auto-renew
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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
Blue Cross and Blue Shield of Texas
Health insurance (payer) · Richardson, Texas

Renewal timeline

  1. Effective date
    Agreement commencement.
    2022-04-01
    Past
  2. Amendment executed
    Outpatient fee-schedule refresh (+1.6% blended).
    2025-04-01
    Past
  3. Notice deadline
    Last day to give non-renewal notice before evergreen renewal.
    2026-12-31
    Upcoming
  4. Expiration
    Auto-renews unless noticed.
    2027-03-31
    Upcoming

Extraction & review progress

Verified
4 of 4 terms resolved · 4 verified100%
Approved 0Flagged 0Rejected 0Pending 4

Risk flags

2
  • 2 obligations at risk
    Pay per Attachment 1 fee schedule; Correct outpatient bundling edits
    medium
  • 3 linked exceptions
    3 open spend/revenue exception(s) totaling recoverable/avoidable value against this counterparty.
    high

Extracted terms

Showing 4 of 4 terms
Expected net revenue (annual)Rates & feeshigh confidence
$18,900,000
§ Reimbursement · p.2
pending
TermDates & termhigh confidence
Evergreen — annual review
§8.1 Term · p.3
pending
Fee scheduleRates & feeshigh confidence
Attachment 1 (locked)
Attachment 1 · p.9
pending
Clean-claim paymentDates & termhigh confidence
21 days
§5.2 · p.3
pending

Rates, fees & escalators

Annual value
$18.9M
Term length
59 months
Total contract
$92.9M
  • Expected net revenue (annual): $18,900,000§ Reimbursement
  • Fee schedule: Attachment 1 (locked)Attachment 1
Escalators / value changes
  • 2025-04-01 — Outpatient fee-schedule refresh+1.6% blended

SLAs & KPIs

Financial (Yield) · 35%
Target: ≥ 98% expected yield · Actual: 97.6% yield · Expected-vs-paid model
At risk
Service (Adjudication) · 20%
Target: ≤ 21d clean pay · Actual: 19d avg · Remittance timing
Meeting
Contract Compliance · 25%
Target: Fee schedule honored · Actual: 1 bundling variance · 835 variance model
At risk
Responsiveness · 12%
Target: Dispute ≤ 30d · Actual: 24d avg · Dispute log
At risk
Risk & Documentation · 8%
Target: Contract on file · Actual: Current · Managed-care file
Meeting

Obligations

0 reviewed
  • Pay per Attachment 1 fee schedule
    Attachment 1 · Per claim
    At risk
  • Correct outpatient bundling edits
    §5.4 · Per claim
    At risk
  • Adjudicate clean claims within 21 days
    §5.2 · Per claim
    On track

Version history

  1. Original execution
    2022-04-01 — Statewide Blue Plan Participation Agreement executed.
  2. Amendment 1CurrentViewing
    2025-04-01 — Outpatient fee-schedule refresh (+1.6% blended)

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

Linked spend / revenue exceptions

$144K
  • Underpayment
    Outpatient bundling edit applied against fee schedule.
    EX-2010 · In review
    $88,500
  • Denial variance
    Timely-filing denials on resubmitted secondary claims.
    EX-2011 · Awaiting vendor
    $33,000
  • Underpayment
    Observation-rate variance on short-stay claims.
    EX-2012 · Open
    $22,000