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programs, pharmacy and specialty pharmacy programs, pharmacy benefit substitution process, referral
<br />management, quality assurance and improvement programs and Medical Necessity oversight.
<br />Provider further agrees to share Participant information as specifically related to the Medical Management
<br />Program and utilization management functions described above. Provider is required to allow access to
<br />Participant records, provide for copying and release of records, and to speak to the FCHN or Payor Medical
<br />Director or designee upon request, as allowed by applicable law and regulation, in a timely manner to facilitate the
<br />Medical Management Program and utilization review. Non-compliance with the Medical Management Program
<br />may result in non-payment of Provider by Payor.
<br />2.10 Subcontracts
<br />If Provider subcontracts with any other provider to provide Covered Services to Participants hereunder, Provider
<br />understands and agrees that the subcontract and the subcontracting provider must comply with all terms of this
<br />Agreement and applicable state law and regulation.
<br />2.11 Non -Covered Services/Exclusions
<br />Provider shall provide notice to Participant of Participant's personal financial obligations for non -covered services,
<br />which includes services that are not Medically Necessary. Provider may bill a Participant for non -covered
<br />services only if Provider has, prior to the provision of non -covered services, obtained a written acknowledgment
<br />and acceptance of financial responsibility for such services from the Participant after full disclosure to Participant
<br />of (i) Provider's intent to bill Participant for non -covered services, and (ii) the non -liability of FCHN or Payors for
<br />such non -covered services.
<br />2.12 FCHN Provider Policies and Procedures
<br />Providers shall comply with all Provider Policies and Procedures which are electronically accessible to Provider,
<br />as updated with sixty (60) days advance notice to Provider, or if applicable, the notice described in Section 3.2
<br />below, including, but not limited to, billing and claims payment, provider credentialing, Participant grievances,
<br />appeal and adverse benefit determination procedures, Utilization Review, quality management, data reporting
<br />requirements, pharmacy benefit substitution processes, confidentiality requirements and any applicable federal or
<br />state requirements. Subject to any continuation of care provisions of this Agreement, Provider may terminate this
<br />Agreement in accordance with Section 8.2.1 if Provider does not agree with such updates. In the event that any
<br />provision in the Provider Policies and Procedures or any amendment thereto is inconsistent with the terms of this
<br />Agreement, the terms of this Agreement shall control.
<br />2.13 Claims Payment
<br />Provider shall look only to Payors for payment of claims. FCHN is not a guarantor of, or in any way responsible to
<br />Provider for, any claim payments.
<br />2.14 Acceptance of Payment
<br />Provider shall seek and accept payment from Payors for Covered Services as outlined in Schedule B to this
<br />Agreement in accordance with the FCHN Provider Policies and Procedures and the applicable Benefit Plan,
<br />Provider shall have the right to bill, charge, or collect a deposit directly from the Participant for any applicable
<br />Deductible, Co -payment, or Coinsurance, or, consistent with Section 2.11, for any service that is not a Covered
<br />Service. In no event may Provider bill or collect from Participants any difference between Provider's charges and
<br />the amount of the FCHN fee schedule for Covered Services set forth in Schedule B.
<br />2.15 Compliance
<br />Provider agrees to comply with all of the terms of this Agreement, all applicable federal and state laws and
<br />regulations, all applicable rules and standards of accrediting agencies having jurisdiction over and designated by
<br />FCHN, and as applicable, the ethical standards of the American Medical Association, all of the above as they may
<br />be adopted, amended, revised, or renumbered.
<br />2.16 Provider Group
<br />Where Provider is a Provider Group, Provider agrees to ensure that the licensed physicians and other healthcare
<br />providers comprising the Provider Group are informed of, and agree to comply with and be bound by, the terms of
<br />this Agreement.
<br />FCHN-PRO-042016
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