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m.a.nual(s), notices and.communications related to this Agreement, the term "Member" may be used interchangeably
<br />with the terms lnsured, Covered Porson, Covered lndlvidual, Enrollee, Subscriber, Dependent Spouse/Domestic
<br />Partner, Child, Beneficiary or Gontract Holder, and the meaning of each is synonymous with any such other.
<br />"Network" means a group of providers that support, through a direct or indirect contractual rolationship, one or moro
<br />product(s) and/or program(s) ln which Members are enrolled.
<br />"Other Payors" means persons or entities, pursuant to an agreement with Wellpoint or an Affillate, that access the rates,
<br />terms or conditione of thls Agreement with respect to certain Network(s), excludlng Govemment Programs unless
<br />othenrlse set forth in any Participation Attachment(s) for Government Programs. Other Payors include, wlthout
<br />llmitation, employers or insurers providing Health Benefit Plans pursuant to partially or wholly insured, self-administered
<br />or eelf-insured programs.
<br />"Participating Provider" means a person, lncluding but not limlted to, a physician or other health care professional or
<br />entity, including but not limited to a hospltal, health care faclllty, a partnership of sush professionals, or a professional
<br />corporation, or an employee or subcontractor of such person or entity, that is pafi to an agreement to provide Covered
<br />Services to Members that has met all appllcable requlred Plan credentialing requirements, standards of partlcipation
<br />and accreditation requirements for the seMces the Participating Provider provides, and that is dosignated by Plan to
<br />participate in one or more Network(s). Unless othenivlse specifically delineated, all references herein to "Provider" may
<br />also mean and refer to "Participating Provider".
<br />"Participation Attachment(s)" m€ans the document(s) attached hereto and incorporated herein by reference, and which
<br />idsntifies the additional duties and/or obllgations related to Network(s), Government Program(s), Health Benefrt Plan(s),
<br />and/or Plan programs such as quality and/or incentive programs.
<br />"Plan" means Wellpoint, an Afflllate, and/or an Other Payor. For purposes of thls Agreement, when the term "plan"
<br />applles to an entlty other lhan Wellpolnt, "Plan" shall be construed to only mean such entity (i.e., the financially
<br />responsiblo Affiliate or Other Payor under the Member's Health Benefit Plan),
<br />"Plan Compensatlon Schedule" and 'Plan Compensation Schedule Attachment" (collectlvely "PCS") means the
<br />document(s) attached hereto and incorporated heroln by reference, and whic*r set forth the Wellpoint Rate(s) and
<br />compensation related terms for the Network(s) in whlch Provider participatos. The PGS may lnclude provider type,
<br />additional Provider obligatlons and specific Wellpoint compensation related terms and requirements,
<br />"Regulatory Reguirements" means any requlremonts, as amended from time to time, imposed by appllcable federal,
<br />state or local laws, rules, regulations, guidelines, instructlons, Government Contract, or othenrulse imposed by an
<br />Agency or government regulator in connection wfth the procurement, development or operation of a Health Benefit
<br />Plan, or the performance required by elther party under this Agreement. The omission from ihis Agreement of an
<br />express reference to a Regulatory Requirement applicable to either party in connection with their duties and
<br />responsibilities shall ln no way limit such party's obligation to comply with such Regulatory Requlrement.
<br />"Wellpolnt Rate" means the lesser of one hundred percent (100%) of Eligible Charges for Covered Sorvlces, or the
<br />total relmbursement amount that Provider and Wellpoint have agreed upon as set forth in the Plan Compensation
<br />Schedule ['PCS"). The Wellpoint Rate includes applicable Cost Shares, and shall represent payment ln full to Provider
<br />for Covered Servicos.
<br />ARTICLE II
<br />SERVICES/OBLIGATIONS
<br />2.1 Membor ldentlflcatiqn. Wellpoint shall ensure that Plan provides a means of idenlifying Member either by
<br />issuing ? Paper, plastic, electronic, or other identificatlon document to Member or by a telephonic, paper or
<br />electronic communication to Provider. This identification need not include all information necessary to
<br />determine Member's eligibility at the time a Health Service ls rendered, but shall include lnformation necessary
<br />lo conlact Plan to determine Membefs participation ln the applicable Health Beneflt Plan. Provider
<br />acknowledges and agrees that possession of such identification document or ability to access eligibility
<br />information telephonically or electronically, in and of itself, does not qualifo the holder thereof as a Member,
<br />nor does the lack thereof mean thal the person is nol a Member. Wellpoint shall ensure that Provider furnish
<br />Health Servlces to each Medicaid Memberwlthout regard to the Medicaid Member's enrollment in the plan as
<br />a private purchaser of the plan or as a participant in publicly financed programs of health care services, This
<br />requirement does not apply to circumstances when the provider should not render services due to limitatlons
<br />arising from lack of training, experience, skill, or licensing rostrictlons."
<br />Washlngton Enterprlse Provider Agro6m6nt PCS
<br />O 2024 July.- WellpolntWashlngton, lnc,2 1183932156
<br />05/05/2025
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