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2.7.8 This section neither permits nor precludes Wellpoint from recovering from a Member any amounts
<br />paid to Provider for benefits to which the Member was not entitled under the terms and conditions of
<br />the Health Benefit Plan.
<br />2.8 Use of Subcontractors. Provider and Plan may fulfill some of their duties under this Agreement through
<br />subcontractors. For purposes of this provision, subcontractors shall include, but are not limited to, vendors
<br />and non -Participating Providers that provide supplies, equipment, staffing, and other services to Members at
<br />the request of, under the supervision of, and/or at the place of business of Provider. Provider shall provide
<br />Wellpoint with thirty (30) days prior notice of any Health Services subcontractors with which Provider may
<br />contract to perform Provider's duties and obligations under this Agreement, and Provider shall remain
<br />responsible to Plan for the compliance of his/her/its subcontractors with the terms and conditions of this
<br />Agreement as applicable, including, but not limited to, the Payment in Full and Hold Harmless provisions
<br />herein.
<br />2.9 Compliance with Provider Manual(s) and Policies Programs and Procedures. Provider agrees to cooperate
<br />and comply with, Wellpoint's provider manual(s), and all other policies, programs and procedures (collectively
<br />"Policies") established and implemented by Plan applicable to the Network(s) in which Provider participates.
<br />Wellpoint or its designees may modify the provider manual(s) and its Policies by making a good faith effort to
<br />provide notice to Provider at least sixty (60) days in advance of the effective date of material modifications
<br />thereto.
<br />2.10 Referral Incentives/Kickbacks. Provider represents and warrants that Provider does not give, provide,
<br />condone or receive any incentives or kickbacks, monetary or otherwise, in exchange for the referral of a
<br />Member, and if a Claim for payment is attributable to an instance in which Provider provided or received an
<br />incentive or kickback in exchange for the referral, such Claim shall not be payable and, if paid in error, shall
<br />be refunded to Wellpoint.
<br />2.11 Networks and Provider Panels. Provider shall be eligible to participate only in those Networks designated on
<br />the Provider Networks Attachment of this Agreement. Provider shall not be recognized as a Participating
<br />Provider in such Networks until the later of: 1) the Effective Date of this Agreement or; 2) as determined by
<br />Plan in its sole discretion, the date Provider has met Plan's applicable credentialing requirements, standards
<br />of participation and accreditation requirements. Provider acknowledges that Plan may develop, discontinue,
<br />or modify new or existing Networks, products and/or programs. In addition to those Networks designated on
<br />the Provider Networks Attachment, Wellpoint may also identify Provider as a Participating Provider in
<br />additional Networks, products and/or programs designated in writing from time to time by Wellpoint. The terms
<br />and conditions of Provider's participation as a Participating Provider in such additional Networks, products
<br />and/or programs shall be on the terms and conditions as set forth in this Agreement unless otherwise agreed
<br />to in writing by Provider and Wellpoint.
<br />In addition to and separate from Networks that support some or all of Plan's products and/or programs (e.g.,
<br />HMO, PPO and Indemnity products), Provider further acknowledges that certain Health Services, including by
<br />way of example only, laboratory or behavioral health services, may be provided exclusively by designated
<br />Participating Providers (a "Health Services Designated Network"), as determined by Plan. Provider agrees to
<br />refer Members to such designated Participating Providers in a Health Services Designated Network for the
<br />provision of certain Health Services, even if Provider performs such services. Notwithstanding any other
<br />provision in this Agreement, if Provider provides a Health Service to a Member for which Provider is not a
<br />designated Participating Provider in a Health Services Designated Network, then Provider agrees that
<br />he/she/it shall not be reimbursed for such services by Wellpoint, Plan or the Member, unless Provider was
<br />authorized to provide such Health Service by Plan.
<br />2.12 Change in Provider Information. Provider shall immediately send written notice, in accordance with the Notice
<br />section of this Agreement, to Wellpoint of:
<br />2.12.1 Any legal, governmental, or other action or investigation involving Provider which could affect
<br />Provider's credentialing status with Plan, or materially impair the ability of Provider to carry out
<br />his/her/its duties and obligations under this Agreement, except for temporary emergency diversion
<br />situations; or
<br />2.12.2 Any change in Provider accreditation, affiliation, hospital privileges (if applicable), insurance,
<br />licensure, certification or eligibility status, or other relevant information regarding Provider's practice
<br />or status in the medical community.
<br />Washington Enterprise Provider Agreement PCs 5 1183932156
<br />0 2024 July— Wellpoint Washington, Inc. 05105/2025
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