- Contracting with health-insurance payers and acting as a liaison with payers regarding operational/financial issues that arise in the practices
- Enabling nurse case managers who are primarily focused on assisting practices to meet the quality and pay-for-performance metrics in the contracts in order to maximize performance and profits, with the goal of helping the practices to provide clinically appropriate and effective care
- Providing tools and data to physicians so they can practice with the best-in-class technology in order to maximize patient care and outcomes
- Enabling physicians to provide personalized, high-quality, cost-effective, efficient and safe healthcare to their patients and cohesively support each other in the independent practice of medicine
- Providing comprehensive health, dental and disability-insurance and other work-life benefits to physicians and their staff and families
- Providing a retirement plan to physicians
- Allowing equity-sharing with physicians
- Representing first and foremost, via a physician-led Board, the interests of physicians and patients
- Maintaining and supporting one of the lowest-cost networks in the state
To get started, please complete the SHCN Central Mass Local Chapter Prospective Member Application, which can be accessed by clicking on the Join Now button, below. Once it is completed, please submit via our web page or print the form and fax it to our office at 508-438-0236 or e-mail it to [email protected] . If you require additional information about joining our organization, please contact Kristine Rubino at 508-438-1100.Join Now
An Independent Practice Association, or IPA, contracts with independent physicians and provides services to managed-care organizations on the basis of either a negotiated per-capita rate, a flat-retainer fee, or a negotiated fee-for-service.
The SHCN Central Massachusetts Local Chapter is an IPA that is located on the third floor of 427 Main St. in downtown Worcester.
CMIPA APPEAL PROCESS
(FOR NON-MEDICARE AND NON-MEDICAID PATIENTS)
Your doctor is a member of SHCN, a provider organization that is certified as a “risk-bearing provider organization” (RBPO) by the Massachusetts Division of Insurance. An RBPO is a group of health care providers that work together to coordinate your care and enter into financial agreements with insurance companies to do so.
Under Massachusetts law, as a patient of an RBPO, you have the right to make a complaint and use an appeals process to resolve your complaint. There are different appeal processes for different issues.
However, if your complaint pertains to the following matters, and as further defined in 958 CMR 3.020, then it should be directed towards your health insurance plan:
• A decision to not pay for a service that is a benefit under your plan
• A decision that you are not eligible to enroll in the health plan
• A decision to reduce or terminate a covered service that you have been receiving under your health insurance
• A determination that care is not medically necessary
• A determination that you are not eligible for a particular benefit
• A determination that the treatment is experimental or investigational to cancel your coverage
When your complaint pertains to issues like referrals, timely access to treatment or services and other concerns about limitations of care, then you should appeal to SHCN.
If the matter pertains to a SHCN decision, you can contact, Kris Rubino, SHCN Central Mass Appeals Coordinator, to ask about this appeals process or to file a complaint. You can choose a person (such as a spouse, family member, friend, attorney or legal guardian) to act as your representative to help you with your complaint.
You may file a complaint by contacting the SHCN Appeals Representative in the following ways:
To file a complaint by phone – 508-438-1100 x236
To file a complaint in writing – 427 Main Street, 3rd Floor Worcester, MA 01608
We will give you a written answer to your complaint in fourteen (14) days. If your complaint involves urgent medical needs, we will give you a written answer in three (3) days.
For more information or questions, call 508-438-1100 x236. For more information on your right to make a complaint, contact the Massachusetts Office of Patient Protection at 800-436-7757.
To find one of our primary-care or specialty-care physicians.
click on the Find a Physician button below:Find A Physician
Established in 1998, the SHCN Central Massachusetts Local Chapter (previously named Central Massachusetts Independent Physicians Association) is a physician-governed organization that provides support, services and equity to independent physicians in Worcester County. We enable our physicians to provide high-quality care to their patients and support each other in independent practice. We are one of the lowest-cost networks in the state.
Our physician leaders have the responsibility of guiding us through change, sharing information and developing ideas about the best ways to provide effective, efficient, and safe healthcare. We strive to develop cohesive relationships among our members/providers to ensure that patients receive timely access to healthcare services. Our collective strength enables our members to manage their practices efficiently and to receive fair compensation for the care they provide.
We provide tools and data so that our members can practice with the best-available technology and most up-to-date clinical information. Our goal is to consistently achieve healthcare outcomes that improve the health of our patients. We seek to build relationships with hospitals, health plans and community agencies to support our mission and to enhance quality healthcare.
We are located on the third floor of 427 Main St. in downtown Worcester.
To find one of our primary-care or specialty-care physicians.Find a Physician