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2.6 2.5 2.7 2.8 2.9 2.10 2.',|1 3.1 abuse, or mlsconduct to Wellpoint. Provider shall also refer all potsntlal allogations of fraud to HCA and the Medlcald Fraud Control Division (MFCD) as described in 42 C.F.R S 455.23. Plan Marketing/lnformation Requirementg. Provider agrees to abide by Plan's marketing/information requirements. Providor shall fonivard to Plan for prior approval all ffyers, brochures, lefters and pamphlets Provider intends to distribute to Wellpoint's Medlcaid Members concerning its payor afliliations, or changes in affiliation or relating directly to the Medicaid population. Provlder wlll not dlstribute any marketing or reclplent informing materials wlthout the consent of PIan or the applicable State Agency. Schedule of Beneflts and Determin_qlion of Medicaid Covered SeMceq. Wellpoint shall make available upon Provider's request schedules of Medicaid Covered $ervices for applicable Mediceid Program(s), and will notify Provlder in a timely manner of any material amendments or modificatlons to such schedulos. Medicaid Member,Verification. Provider shall establish a Medicaid Member's eligibitlty for Medicaid Covered Servlces prior to rendering services, except in the case of an Emergency Condltion, as deflned in the PCS, where such verification may not be possible. ln the case of an Emergency Condition, Provlder shall establish a Medicaid Member's eligibility as soon as reasonably practical. Plan shall provide a system for Provlders to contact Plan to verifo a Medicaid Member's eligibility twenty-four (24) hours a day, seven (7) days per week. Nothing contained in this Attachment orihe Agreement shall, or shall be construed to, require advance notice, coverage veriflcation, or pre-authorization for Emergency Services, as defined in the PCS, provided in accordance with the federal Emergency Medical Treatment and Labor Act ("EMTALA") prlor to Provider's renderlng such Emergency Services. H.qspital Affiliation and Privileges^ To the extent required under Plan's credentiallng requirements, Provider or any Partlcipating Providers employed by or under contract or subcontract with Provider shall malntain privileges to practice at one or more of Wellpoint's participating hospitals orfurnish documentation to Wellpoint that rsferral anangements have been made wlth another Wellpoint contracted provider to assume the Participating Provider admission responsibilities of Provider. ln addition, ln accordanco with the Change in Provlder lnformation Section of the Agreement, Provlder shall immediately notifu Wellpoint ln the event any such hospital privileges are revoked, limited, surrendered, or suspended at any hospital or health care facility. P.artipipatinq Provider Roquirements. lf Frovider is a group provider, Providershall require that all Participating Providers employed by or under contract or subcontract with Provlder comply wlth all terms and conditions of the Agreement and thls Aftachment. Notwithstanding the foregoing, Provider acknowledges and agrees that Wellpoint is not obligated to accept as Participating Providers all providers employed by or under contract or subcontract with Provider. Coordlnated and Managed Care. Provider shall participate in utilizatlon management and care management programs designed to facilitate the coordination of services as referenced in the applicable provider manual(s), Ropresentatlons.and Warradies. Provider represents and warants that all information provided to Wellpolnt is true and correcl as of the date such information ls furnished, and that Provider is unaware of any undisclosed factsorcircumstancesthatwouldmakesuchinformationinaccurateormisleading. Providerfurtherrepresents and warrants that Provider: (i) is legally authorized to provide the services contemplated hereunder; (ii) is qualified to partlcipate in all applicable Medicaid Program(s); (ili) is not in violation of any licensure or accrodltation requirement applicable to Provider under Regulatory Requirements; (lv) has not been convicted of bribery or attempted bribery of any official or employee of the jurisdicfion in which Provlder operates, nor mado an admlsslon of guilt of such conduct which is a mafter of record; (v) is capable of providing all data related to the services provided hereunder in a timely manner as reasonably required by Wellpoint to satisff its internal requlrements and Regulatory Requirements, including, without limitation, data requirod under the Healthcare Effectiveness Data and lnformation Set ("HEDIS") and National Commlttee for Quality Assurance ("NCQA") requirements; and (vi) is not, to Provider's best knowledge, the subject of an inquiry or lnvestigation that could foreseeably result in Provlder failing to comply with the representations set forth horeln, ln accordance with the Change In Provider lnformation Section of the Agreement, Provider shall immediately provide Wellpoint with written notice of any material changes to such information, ARTICLE III COMPENSATION AND AUDIT Submission and Adjudication of Medicaig Clalms. Unless othenrviee instructed, or required by Regulatory Requirements, Provider shall submit Claims to Plan, using appropriate and current Coded Service ldentifie(s), within three hundred sixty-five (365) days from the date the Health Services are rendered or Plan may refuse Washlngton Enterprlse Provider Agreensnt Medicaid Allachment @ 2024 July - Wellpolnl Washlngton, lno,11 83932156 05105/2025 19