SHJ25-008 COORDINATED CARE CONTRACT - PARTIALLY EXECUTED

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Persons, within the scope of the Contracted Provider's license and in accordance with generally accepted standards of the Contracted Provider's practice and business and in accordance with the provisions of this Agreement and Regulatory Requirements. 2.4. Policies and Procedures. Provider warrants that Provider and Contracted Providers shall at all times cooperate and comply with applicable administrative requirements, policies, programs and procedures of Company and Payor, which may include, but are not limited to, the following: credentialing criteria and requirements; confidentiality and notification requirements; medical management programs; claims and billing, quality assessment and improvement, utilization review and management, disease management, case management, on -site reviews, referral and prior authorization, and grievance and appeal procedures; coordination of benefits and third party liability policies; carve -out and third party vendor programs; and data reporting requirements. The failure to comply with such policies and procedures could result in a denial or reduction of payment to the Provider or Contracted Provider or a denial or reduction of the Covered Person's benefits. Such policies and procedures do not in any way affect or remove the obligation of Contracted Providers to render care. Health Plan shall make the applicable policies available to Provider and Contracted Providers prior to contracting and throughout the term of the Agreement upon reasonable request via one or more designated websites or alternative means. Company shall notify Provider at least 60 days in advance of changes in administrative policies and procedures that affect Provider's compensation or health care service delivery unless changes to federal or State law or regulations make such advance notice impossible, in which case notice will be provided as soon as possible. Such notice may be given by Health Plan through an update to information available to Provider online, or any other written method (electronic or paper). Provider shall notify Contracted Providers of such changes. 2.5. Credentialing Criteria. Provider and each Contracted Provider shall complete Company's and/or Payor's credentialing and/or recredentialing process as required by Company's and/or Payor's credentialing policies, and shall at all times during the term of this Agreement meet all of Company's and/or Payor's credentialing criteria. Provider and each Contracted Provider represents, warrants and agrees: (a) that it is currently, and for the duration of this Agreement shall remain: (i) in compliance with all applicable Regulatory Requirements, including licensing laws; (ii) if applicable, accredited by The Joint Commission or the American Osteopathic Association; and (iii) a Medicare -certified provider under the federal Medicare program and a Medicaid participating provider under applicable federal and State laws; and (b) that all Contracted Providers and all employees and contractors thereof will perform their duties in accordance with all Regulatory Requirements, as well as applicable national, State and local standards of professional ethics and practice. No Contracted Provider shall provide Covered Services to Covered Persons or identify itself as a Participating Provider unless and until the Contracted Provider has been notified, in writing, by Company that such Contracted Provider has successfully completed Company's credentialing process. 2.6. Eligibility Determinations. Provider or Contracted Provider shall timely verify whether an individual seeking Covered Services is a Covered Person. Company or Payor, as applicable, will make available to Provider and Contracted Providers a method whereby Provider and Contracted Providers can obtain, in a timely manner, general information about eligibility and coverage. Company or Payor, as applicable, does not guarantee that persons identified as Covered Persons are eligible for benefits or that all services or supplies are Covered Services. If Company, Payor or its delegate determines that an individual was not a Covered Person at the time services were rendered, such services shall not be eligible for payment under this Agreement, except to the extent such services were expressly authorized by Company or Payor. For retrospective review, eligibility determinations will be made solely on the medical information available to the Contracted Provider at the time the health service was provided. Such retrospective review will be completed within 30 calendar days of receipt of the necessary information. hi addition, Company will use reasonable efforts to include or contractually require Payors to clearly display Company's name, logo or mailing address (or other identifier(s) designated from time to time by Company) on each membership card. 2.7. Referral and Preauthorization Procedures. Provider and Contracted Providers shall comply with referral and preauthorization procedures adopted by Company and/or Payor, as applicable, prior to referring a Covered Person to any individual, institutional or ancillary health care provider. Unless otherwise expressly authorized in writing by Company or Payor, Provider and Contracted Providers shall refer Covered Persons only to PPA WA - Kittitas County Public Health - 05.07.2025-1CMProviderAgreement_360268 Page 4 of 24