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1.20 Utilization Review means the prospective, concurrent, or retrospective assessment of the necessity and appropriateness of the allocation of health care resources and services of a provider or facility given or proposed to be given to a Participant. 2. RESPONSIBILITIES OF PROVIDER 2.1 Provide or Arrange for Covered Services For each Participant, Provider shall provide, or arrange for the provision of Covered Services on a timely basis, without regard to health status or medical condition, and in accordance with generally accepted medical practice guidelines and standards pursuant to the terms of this Agreement, and in accordance with applicable FCHN Provider Policies and Procedures. Except in the case of an Emergency Medical Condition, Provider agrees to verify each Participant's eligibility prior to providing Covered Services. In the case of an Emergency Medical Condition, Provider will notify FCHN or the appropriate Payor of the provision of Medically Necessary services to treat a Participant's Emergency Medical Condition during the first business day immediately following the provision of such services. Provider agrees to furnish Covered Services to each Participant on the same basis as such services are made available to individuals who are not Participants, and without regard to the Participant's enrollment in FCHN as a private purchaser or as a participant in publicly financed programs of health care services. In providing services under this Agreement, Provider shall exercise the degree of care, skill, and knowledge expected of a reasonably prudent health care provider and in a manner consistent with currently approved methods and practices in Provider's medical specialty. Provider shall exercise his or her own professional medical judgment, free of any direction or control by FCHN, and shall remain solely responsible for the quality of services rendered. 2.2 Accessibility and Hours of Service Provider shall arrange for the provision of Covered Services to Participants during normal business hours at the usual places of business of Provider. Provider shall ensure that Provider arranges for and maintains call schedules that provide appropriate call coverage to Participants in the event Participants are unable to contact their Participating Providers. 2.3 Primary Care Providers (PCP's) For Participants enrolled in Benefit Plans requiring a referral, PCP's are intended to be the patient's first source of care. PCPs are required to comply with any applicable Medical Management and Quality Improvement programs as outlined in Section 2.9. Some Participant Benefit Plans may require the PCP to facilitate Medically Necessary Specialist Provider referrals via an approved process. In those instances, Provider agrees to provide referrals in accordance with the approved process. If the type of specialist needed for a specific condition is not represented in the Participant's Benefit Plan's panel of Participating Providers, the PCP will facilitate a referral to a medically appropriate non -participating specialist. 2.4 Specialist Providers Specialist Providers shall adhere to the degree of responsibility requested by the referring FCHN PCP. For Participants enrolled in Benefit Plans requiring referrals by a PCP, the Specialist Provider shall also communicate to the referring PCP regarding the Participant's evaluation and treatment plan. Specialist Providers are required to comply with any applicable Medical Management, Utilization Review, and Quality Improvement programs as described in Section 2.9. The Primary Care Provider, in conjunction with the Specialist Provider, shall decide whether follow-up care shall be provided by the Primary Care Provider or through continued specialty referral. 2.5 Benefit Plan Provider hereby authorizes Payors contracting with FCHN to offer Provider's services to groups of employees or individuals in accordance with the provisions of any Benefit Plans offered by such Payors. Nothing in this Agreement shall have the effect of modifying benefits, terms or conditions contained in a Benefit Plan. In the event of any conflict between this Agreement and a Benefit Plan, the benefits, terms and conditions of the Benefit Plan shall govern with respect to Covered Services provided to Participants in the Benefit Plan. Provider's services are not offered in connection with motor vehicle insurance, personal injury protection, workers FCHN-PRO-042016