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2.4
<br />2.2
<br />2.3
<br />2.5
<br />2.6
<br />Washlngton Enterpdse Provlder Agro8m€nt Pcs
<br />@ 2024 July- Wollpolnl Washlnglon, lnc,
<br />Plgvider Non-discrimination. Provider shall provide Health Servlces to Members in a manner slmllar to and
<br />wlthin the same time availability in which Provlder providea Health Services to any other individual. Provider
<br />will not differentiate, or discriminate against any Member as a result of his/her enrollment ln a Health Benefit
<br />Plan, or because of race, color, creed, national origin, ancestry, religion, $ex, marilal slatus, age, dlsabllity,
<br />paymentsource, stale of health, need for Health Servlces, status as a litigant, status as a Medicare or Medicaid
<br />beneficiary, sexual orientation, gender identity, or any other basis prohibited by law, Provlder shall not be
<br />required to provide any type, or klnd of Health Service to Members that helshefit does not customarily provide
<br />to others. Additional requirements may be set forth in the applicable Participaiion Attachmen(s),
<br />Publication and Vse of Provider lnFrmation. Provlder agrees that Wellpolnt, Plans or their designees may
<br />use, publish, disclose, and display, for commercially reasonable general buslness purpo$es, elthei directy or
<br />through a third party, information related to Provider, including but not limited to demographic information,
<br />information regarding credentialing, affiliations, performance data, Wellpolnt Rates, and lnformafion related to
<br />Provider for transparency initiatives.
<br />Use.oJ Symbpls and MaflS. Neither party to this Agreement shall publish, copy, reproduce, or use in any way
<br />the other party's symbols, service mark(s) or trademark(s) wlthout the prior written consent of such other party.
<br />Notwithstandlng the foregoing, the parties agree that they may ldentiff Provider as a participant ln the
<br />Network(s) ln which he/she/it particlpates.
<br />Submlssion and Adjudicatipn of Claim.g. Providershall submit, and Plan shalladjudlcate, Claims in accordance
<br />with the applicable Partlcipation Attachment(s), the PCS, the provider manual(s) and Regulatory
<br />Requirements. lf Provider submits Claims priorto receiving notice of Wellpoint's approval pursuant to section
<br />2.13, then such Claims must be submitted in accordance wlth prior authorization requirements, and shall be
<br />processed as out of network. Wellpoint shall not make reiroactive adjustments wlth respect to such Claims.
<br />Bqyment in Full and Hold Harmless,
<br />2.6.1 Provlder agrees tro accept as payment in full, in all circumstances, the applicable Wellpoint Rate
<br />whether such payment is ln the form of a Cosl Share, a payment by Plan, or a payment by another
<br />source, such as through coordlnation of benefits or subrogation. Provider shall bill, collect, and
<br />accept compensation for Cost Shares. Provider agrees to make reasonable efforts to veriff Cost
<br />Shares prlor to billing for such Cost Shares. ln no event shall Plan be obligated to pay Provider or
<br />any person acting on behalf of Provlder for services that are not Covered Services, or any amounts
<br />in excess of the Wellpoint Rate less Cost Shares or payment by another source, as set forth above.
<br />Consistent with the foregoing, Provider agrees to accept the Wellpoint Rate as payment in full if the
<br />Member has not yet satisfied his/her deductiblo.
<br />2.6.2 Except as expressly permitted under Regulatory Roqulrements, Provider agrees that in no event,
<br />lncludlng, but not limited to non-payment by Wellpoint, Wellpoint insolvency, or breach of Sris
<br />Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration, or
<br />reimbursement from or have any recourse agalnst a Member, any person acting on behalf of a
<br />Member, or HCA for services providod pursuant to this Agreement. This provision shall not prohibit
<br />collection of deductibles, copayments, coinsurance and/or payment for noncovorod services, which
<br />have nol otherwise been paid by a primary or secondary issuer in accordance with the terms of
<br />regulatory standards for coordination of benefits, from a Member in accordance with applicable
<br />Government Contracts or Agency requirements. This provision supersedes any oral or written
<br />conlrary agreement now exisling or heroafter entered into between Provider and a Member or
<br />persons acting on such Member's behalf, Provider agrees, in the evenl of Wellpoinfs lnsolvency, to
<br />continue to provide the services promised in this Agreement to Members of Wellpoint forthe duration
<br />of the period for which premiums on behalf of the Member were paid to provider or until the Member's
<br />discharge from inpatient facilities, whichever time ls greater. Provider shall not hold Member liable
<br />for payment of any fees that are lhe legal obligation of Wellpoint. Notwithstanding any other provision
<br />of this Agreement, nothlng in this {greement shall be construed to modis the rights and beneflts
<br />contained in the Membe/s hoalth plan, Provider may not bill the Member for Covered Services
<br />(except fordeductibles, copayments, or coinsurance) where Wellpoint denies payments because the
<br />provider has falled to comply with the terms or conditions of this Agreement, Provider further agrees
<br />that the provislons of WAC 284-170-421 (3)(a), (b), (c), and (d) shall survive iermination of this
<br />contract regardless of the cause giving rise to termination and shall be construed to be for the benefit
<br />of Provider's Members. lf Provlder enters into agreements with other providers who agree to provide
<br />Covered Services to Members of Wellpoint, with the expectation of receiving payment directly or
<br />lndirectly from Wellpoint, then such providers must agree to abide by the provisions of WAC 284-
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<br />05n612025
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