Asuris Agreement - Laserfiche WebLink

Home Browse Search

benefits on the date(s) thal such services are rendered. 3.11 GO V.sB_NJll1l;N T _ ROG~A..M S -Medical Group agrees to accept the Medicaid re imbursement made by the Co mpa ny, or th e Company's relm bu rs.emenl, as paym ent In fu ll to r Cove re d Servic es rendered to Me mbera enrolled In 111e State of W,asli ngto_n1 Oepa~t menl of So ci al and Hea lth Services Medic.ii Assistance Prog rams (Med icaid). This provision is intended to cover those Medicaid Members who receive care outside of their assigned Provider Network. In no event shall the Medical Group seek additional reimbursement for Covered Services rendered to such Members . All claims tor Medicaid Members must be submitted within three hundred sixty nve (385) days from the date of service. The Medical Group is not obligated to accept all or any Medicaid Members referred to it, nor is the Medical Group automatically a Participating Provider in the Company's Medicaid programs by accepting the Medicaid reimbursement. Medical Group agrees to report to Company any occurrence in which a Medicaid member is billed for a Covered Service or Non-Covered Service, regardless of Member consent to assume financial liability. IV . COMPLIANCE WITH COMPANY'S POLICIES AND PROGRAMS 4 .1 ~..QfESSIONAL REQY..I~~!;:N1_S. -Medical Group and Medical Group Providers will rema in In full compliance with all applicable laws and regulations governing the practice of medicine and will be duly licensed, in good standing, to practice medicine in Medical Group's respective Jurisdlction(s), including such jurisdictions as may be required by virtue of Medical Group's participation in a Provider Network. Evidence of such llcensure and of Medical Group's DEA certification wlll be made available to Company upon request The Medical Group agrees that it and its subconlractors and employees shall comply with all applicable statutes, laws and regulations, including those set forth in WAC 284-43 and those that govern health care service delivery to Members. Medical Group agrees lo notify Company, In writing, within five (5) working days of any material change in the status of Medical Group which is likely to impair or Interfere with Medical Group's performance under this Agreement Including, but not limited to : (i) loss or suspension of Mcensure or certification ; (ii) placement on probation by professional licensing or certification agency ; (iU) loas or restriction of full active admitting privileges at any hospital; (i11) the iasuance of any formal charges against Medical Group by any governmental agencies, or any other licensing or accreditation organization wtllch would, if sustained, materially impair Medical Group's abiUty to comply wl1h Medical Group's duties and obligations under lhls Agreement; and (v) suspension or expUlsion from the Medicare or Medicaid programs. 4 .2 AOMlli.i_S.IB~TIVE Mi?.N.U-81. -The Company shall make available to the Medical Group copies of the Company's Adminialrative Manual, electronically, which outlines billing requirements, general benefits Information, Medical Management requirements and other updated information. The Medical Group agrees to comply with the policies and procedures set forth in the Administrative Manual and that compliance is necessary to meet the obligations under lhis Agreement. The Company may revise and update the Administrative Manual from time lo time with ninety (90) days' notice to lhe Medical Group . The Medical Group agrees that such revh1ions become a part of the Administrative Manual and the Medical Group agrees to comply with any such revisions . The Medical Group agrees to abide by Company directives, whether communicated by the Company through its Administrative Manual or other communications and publications. Notwithstanding the foregoing, the parties understarid that If there are any conflicts with the Administrative Manual and the Agreement , this Agreement shall prevail. 4 .3 ,UTILl~TIQN MANA GE.M~L AND QUALITY LMP ROVEM~fil -To lhe extent that Medical Group participates in Provider Networks ror Health Plans which have Implemented utilization management and/or quality improvement policies and programs, Medical Group will fully comply with such policies and programs, the details of which are Asurts MGA Agreement (Rev. 0~12017) A18618854AA Page 9 of 20