First CHoice Agreement - Laserfiche WebLink

Home Browse Search

SCHEDULE C PREFERRED PROVIDER/GROUP AGREEMENT WASHINGTON STATE LAW AND REGULATION PROVISIONS With respect to any Payor that is a health carrier or carrier as defined in RCW 48.43.005, as it may be revised, renumbered, or replaced, the provisions set forth in this Schedule C are fully operative and applicable to FCHN, Provider, and the respective Payors under the Agreement to which this Schedule C is attached. For Payors meeting the definition described above, in the event of any conflict between the provisions set forth in this Schedule C and the other terms of the Agreement, the provisions of this Schedule C shall have priority. Except as modified by this Schedule C, all terms and conditions of the Agreement to which this Schedule C is attached remain in full force and effect. With respect to any Payor that is a health carrier or carrier as defined in RCW 48.43.005, as it may be revised, renumbered or replaced: 1. Responsibilities of Provider. Section 2.15 of the Agreement is deleted in its entirety and the following is substituted therefor: 2.15 Compliance Provider agrees to comply with all of the terms of this Agreement, all applicable federal and state laws and regulations, all applicable rules and standards of accrediting agencies having jurisdiction over and designated by FCHN, and the ethical standards of the Washington State Medical Association and the American Medical Association, all of the above as they may be adopted, amended, revised, or renumbered. As required by Washington State law, Provider agrees to comply with the following hold harmless requirements: 2.15.1 Provider hereby agrees that in no event, including, but not limited to, non-payment by a Payor, a Payor's insolvency, or breach of this Agreement will Provider bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against a Participant or person acting on Participant's behalf, other than Payor, for services provided pursuant to this Agreement. This provision does not prohibit collection of Deductibles, Co -payments, Coinsurance, or charges for non -covered services, which have not otherwise been paid by a primary or secondary Payor in accordance with regulatory standards for coordination of benefits, from Participants in accordance with the terms of the Participant's Benefit Plan. 2.15.2 Provider agrees, in the event of a Payor's insolvency, to continue to provide the services promised in this Agreement to Participants for the duration of the period for which premiums on behalf of the Participant were paid to Payor or until the Participant's discharge from in- patient facilities, whichever time is greater. 2.15.3 Notwithstanding any other provision of this Agreement, nothing in this Agreement shall be construed to modify the rights and benefits contained in the Participant's Benefit Plan. 2.15.4 Provider may not bill the Participant for Covered Services (except for Deductibles, Co- payments, or Coinsurance) where a Payor denies payments because Provider or a facility has failed to comply with the terms or conditions of this Agreement. 2.15.5 Provider further agrees that (i) the provisions of paragraphs 2.15.1, 2.15.2, 2.15.3, and 2.15.4 of this subsection 2.15 shall survive termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of the Participants, and that this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between Provider and Participants or persons acting on their behalf. 2.15.6 If Provider contracts with other providers or facilities who agree to provide Covered Services to Participants with the expectation of receiving payment directly or indirectly from a Payor, FCHN-PRO-042016 Sch C - WA