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TRH demo record · fictionalPayer Participation AgreementRenewal window

Commercial Payer Participation Agreement

AGR-UHC-001 · UnitedHealthcare · Commercial Payer

$14.6M
Expected net / yr
Effective
2023-01-01
Expiration
2026-12-31
Notice date
2026-09-30
Term
47 mo
Total contract
$57.2M
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
UnitedHealthcare
Health insurance / benefits (payer) · 9700 Health Care Lane, Minnetonka, MN 55343 (per U.S. HHS TAGGS record; not stated on uhc.com pages fetched)

Renewal timeline

  1. Effective date
    Agreement commencement.
    2023-01-01
    Past
  2. Amendment executed
    Annual fee-schedule update (+2.1% blended).
    2025-01-01
    Past
  3. Notice deadline
    Last day to give non-renewal notice before evergreen renewal.
    2026-09-30
    73d
  4. Expiration
    Auto-renews unless noticed.
    2026-12-31
    Upcoming

Extraction & review progress

Verified
5 of 5 terms resolved · 5 verified100%
Approved 0Flagged 0Rejected 0Pending 5

Missing / contradictory terms

1
  • contradictionContracted obligation "Pay per Attachment 1 fee schedule" (Attachment 1) is currently breached in observed performance — a contradiction between the agreement and delivery that VERIFY surfaces rather than hides.

Risk flags

4
  • Notice window open
    Notice deadline in 73 days (2026-09-30). Auto-renews if missed.
    medium
  • 1 obligation breached
    Pay per Attachment 1 fee schedule
    high
  • 2 obligations at risk
    Adjudicate clean claims within 21 days; Resolve disputes within 30 days
    medium
  • 4 linked exceptions
    4 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 & feeshigh confidence
$14,600,000
§ 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
Notice windowDates & termhigh confidence
90 days before annual review
§8.3 · p.3
pending

Rates, fees & escalators

Annual value
$14.6M
Term length
47 months
Total contract
$57.2M
  • Expected net revenue (annual): $14,600,000§ Reimbursement
  • Fee schedule: Attachment 1 (locked)Attachment 1
Escalators / value changes
  • 2025-01-01 — Annual fee-schedule update+2.1% blended

SLAs & KPIs

Financial (Yield) · 35%
Target: ≥ 98% expected yield · Actual: 96.1% yield · Expected-vs-paid model
Breached
Service (Adjudication) · 20%
Target: ≤ 21d clean pay · Actual: 27d avg · Remittance timing
At risk
Contract Compliance · 25%
Target: Fee schedule honored · Actual: 2 down-code patterns · 835 variance model
At risk
Responsiveness · 12%
Target: Dispute ≤ 30d · Actual: 38d 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
    Breached
  • Adjudicate clean claims within 21 days
    §5.2 · Per claim
    At risk
  • Resolve disputes within 30 days
    §6.1 · As filed
    At risk

Version history

  1. Original execution
    2023-01-01 — Commercial Payer Participation Agreement executed.
  2. Amendment 1CurrentViewing
    2025-01-01 — Annual fee-schedule update (+2.1% blended)

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

Linked spend / revenue exceptions

$214K
  • Underpayment
    Down-code pattern on outpatient E/M claims below fee schedule.
    EX-2001 · In review
    $96,500
  • Denial variance
    Elevated no-authorization denials vs. contract policy.
    EX-2002 · Open
    $61,000
  • Underpayment
    Implant carve-out not applied on two surgical claims.
    EX-2003 · Open
    $38,500
  • SLA breach
    Clean-claim adjudication exceeding 21-day contract window.
    EX-2004 · Open
    $18,000