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Asuris Agreement
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2018-06-05 10:00 AM - Commissioners' Agenda
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Asuris Agreement
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Last modified
1/18/2019 2:03:50 PM
Creation date
1/18/2019 2:03:02 PM
Metadata
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Template:
Meeting
Date
6/5/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Alpha Order
k
Item
Request to Approve an Agreement between Asuris Northwest Health and the Kittitas County Public Health Department
Order
11
Placement
Consent Agenda
Row ID
45299
Type
Agreement
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5.4 RTICIPATION Of OTHEJ;t e.R ... Q¥.!Q§B§..!.!lL!:8ACTICg -Medical Group underarands <br />and agraes that continued partlclpallon n any of Company's Provider Networks requires <br />lha\ all Mecllcel Group Providers must apply and be accepted for participation in the <br />Provider Network . The failure of one or more at the health care providers in Medical <br />Group to be accepted for participation or their relusat to apply for or, upo(l approval , <br />accept such participation, may result In termination of th s Agre _ernent pursuant to ·se<:1!0n <br />7.3. Accordingly, Medical Group must provide Company with at least th irty (30) days' <br />advance notice if one or more phys icians/health care pro11iders intend lo Join Medical <br />Group. <br />5.5 NON-EXQ.USIVITY -This Agreement wlQ not be construed to be an exciusi11e <br />agreemenl between Company and Medical Group. Nothing in this Agreement or any <br />related documents wilt be construed to restr ict lhe particip ation of any of the parties in <br />any olher health ca.re delivery system or payment plan. <br />5.6 ~___Qll!.Q.~V!CES IQ Ml;M 6~F PAYQ~ -Medical Group understands and <br />agrees lhat the Company may enter Into .an <1greement with Payors that want access to <br />and use of I hose Provider N_e\work.s in wh l,ch Medical Group participates . Medical Group <br />hereby authorizes Payors contracting with Company to offer Medical Group's services to <br />groups ot employees or Individuals In accordance with the terms of this Agreement and <br />the pr011ision of any Subscriber Agreement offered or acO:ninl_stered by Payor for the <br />payment of Covered Services. Medical Group agrees to furnish services to Members of <br />such Payers when those Members utilize the Company's Provider Networks in <br />accordance With the same terms and condlllons of partlclpatiOfl and comJM!nsallon as <br />apply when such services are furn ished to Members under th s Agreement. A list of the <br />Company 's subsidlarles and atflllates i s set for1h on Exhibit A hereto. Company will <br />provide Medical Group with ad11ance written notice shoula the list of affiliate$ and <br />subsidiaries in Exhibit 'A change and If Company enters Into an agreement with a Payor <br />that la not specifically named in Sectio n 1. 16 or Exhibit A hereto. <br />5.7 U§E OF NETWORK PROVIDERS --Unless Covered Services are unavailable from <br />Participating Providers , Med cal Group will refer to and accept all coverage from <br />providers who are participaUng In Company's Prov id er Network. <br />5.8 RATE INFORMATIQ.~ -Both parties agree that, unless required by law or authorized <br />by this Agreement, a party shall not disclose the reimbursement rates set forth in this <br />Agre_ernent without prior WI Uen ctlnsent of the other party . The pairtles acknowledge that <br />the unauthorized discfosure of rate lnforrTtatTon may cause Irreparable damage to the <br />other party . Notwlthslandlng the above, Company may disclose to Partee paling <br />Prov ders in Medical Group's service area the information and data required to _allow <br />those Participating Providers to effec1t11ely manage the quality, care and cost of Members <br />Company has altrlbuled to them . Company may also disclose health care claims and cost <br />data to commun ity organizations; such a& Puget Sound Health Alliance (PSHA) that seek <br />·to Improve health care quality and affordability by reporting agg regated data to <br />i,urchaS'Ors of health care serv ices. <br />5.9 DISCLOSURE OF ES TO MEMBEB§ -Notwithstanding any other pro11ision of this <br />Agreement to the contrary, either party may disclose to Members the reimbursement rate <br />or allowed amount set forth In this Agreement for a Co11ered Service and/or the Member's <br />actual or ettlmated cost-.sh arlng amount (e .g., copayment , deductibl e, and/or <br />coinsurance) for a Covered Service lo expla in cla ims payment and lo facilllale informed <br />decisions regarding health care ser11lces use and cost <br />VI. INSURANCE AND INDEMNIFICATION <br />6.1 PROFESSIONAL LIABILITY COVERAGE -Medical Group will obtain, at Medical <br />Group's own cost, and keep in force . adequate policies provldlrtg cornprehen:,lve general <br />lfablll ty , prore9slonal lrablllty Gild other Insurance , as may be necessary ta lnsore Medical <br />Group, Medical Group_'s Providers, age nts and employees agai nst any cla im or cla ims for <br />damages arising out of the rende ri ng of or failure to render proresslonat service~ <br />Asuria MGA Agreement (Rev, 0512D17) A1881886•AA Page 12 of20
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