First Choice Agreement (2) - Laserfiche WebLink

Home Browse Search

8.3.3 Provider shall continue the treatment of Participants who were receiving care in an inpatient facility at the time this Agreement terminated, until one of the following events occurs: (i) the Participant is discharged from the facility, (ii) the FCHN or Payor's Medical Director determines that the care of the Participant can be safely transferred to another facility, or (iii) Payor makes arrangements to transfer the Participant's care to another Participating Provider . 8.3.4 FCHN shall require Payor to cover Covered Services of a Primary Care Provider whose agreement with FCHN is terminated by FCHN without cause under the terms of this Agreement for at least sixty (60) days following notice of termination to the Participants or , in group coverage arrangements involving periods of open enrollment, only until the end of the next open enrollment period. The Provider's relationship with FCHN or Payor must be continued on the same terms and conditions as those of the agreement FCHN is terminating, except for any provision requiring that Payor assign new enrollees to the terminated Provider. 8.4 Notice to Participants If this Agreement is terminated, FCHN shall require Payers to make a good faith effort to provide written notice of the termination to all Participants who are patients seen on a regular basis by Provider within fifteen (15) working days of receipt or issuance of the notice of termination, irrespective of whether the termination was for cause or without cause. If Provider is a PCP, FCHN shall require Payers to make a good faith effort to assure that notice is provided to all Participants who are patients of Provider. 9. DISPUTE RESOLUTION 9.1 Dispute Resolution Process Except as otherwise provided in Section 9.2, the following dispute resolution process will be used to resolve disputes between Provider and FCHN as well as disputes between Provider and Payers . 9.1.1 Informal Process Disputes between Provider and FCHN with regard to performance by either party under !hi!; Agreement , including questions regarding existence, enforceability , interpretation, or validity of this Agreement, shall be resolved, to the extent possible, by informal meetings and discussions between Provider and FCHN. Provider shall promptly notify FCHN and Payor of any failure by a Payor to pay Provider in accordance with the requirements of Section 4.2 of this Agreement, to provide information regarding Participant eligibility and benefit confirmation, to provide any other information required under the terms of this Agreement, or of any disagreement with a determination of Medical Necessity made pursuant to Provider's billing for Covered Services pursuant to this Agreement. Disputes related to the foregoing issues, as well as other disputes between Provider and Payors regarding performance under this Agreement shall be resolved, to the extent possible, by informal meetings and discussions between Provider and the Payor. 9.1.2 Formal Process Where either (i) Provider or FCHN, in the case of a dispute between them, or (ii) Provider or a Payor, in the case of a dispute between them, desires to pursue resolution of a dispute beyond such informal meetings and discussions, either party to the dispute in question may provide the other party to the dispute with written notice, describing the nature of the dispute and the proposed resolution with reasonable particularity, and requesting a response within thirty (30) days after receipt of the notice, or if the dispute involves a billing dispute, within sixty (60) days after receipt of the notice. If the party in receipt of a notice of dispute fails to respond in writing within the above described timeframes or responds in writing disagreeing with the proposed resolution within such timeframes , the party giving notice of the dispute may request mediation of the dispute as set forth below. 9.1.3 Nonbinding Mediation Any party giving notice of a dispute which is not resolved pursuant to Section 9.1 .2 may submit the dispute to nonbinding mediation. After either party to the dispute gives the other a notice of election to FCHN-PRO-042016 12