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2.8
<br />2.9
<br />2.10
<br />2.11
<br />2.12
<br />2.7.B This section neither permits nor precludes Wellpolnt from recovering from a Member any amounts
<br />paid to Provider for benefits to whtch the Member was not entitled under the terms and conditions of
<br />the Health Benefit Plan,
<br />Use of Subcontraetors, Provider and PIan may futfill 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 provlde supplies, equipment, staffing, and other servlces to Members at
<br />t!9 lequest of, under the supervlslon of, and/or at the place of buslness of Provider. Provider shall prcvide
<br />Wellpoint with thirty (30) 9gys prior notice of any Heallh Services subcontractors with which Provlder may
<br />contraci to perform Provider's duties and obligations under this Agreement, and Provider shall remaiir
<br />responsible to Plan for the compliance of his/her/its subcontractors with the terms and condltions of this
<br />Agreement as applicable, includlng, but not limited to, the Payment in Full and Hold Harmless provisions
<br />herein.
<br />Compllance with Provider Manua.(s) and Pqlicies. Proqrams and Procedureq. Provider agrees to cooperate
<br />91d.cgmply with, Wellpoint's provider manual(s), and all other policies, progmms and procedures (collectively
<br />"Policies") established and implemented by Plan applicable to the Network(s) in which Provider farticipates,
<br />Wellpoint or its designees may modifi7 the provider manual(s) and its Pollcies by making a good faith eifort to
<br />provide notice to Provider at least sixty (60) days in advance of the effective date of material modlflcations
<br />thereto.
<br />Referal lncentiv,eslKickbacks. Provider represents and warrants that Provider does not give, provide,
<br />condone or receive any incentives or kickbacks, monotary or othorwise, ln exchange for the refeiral of a
<br />Member, and lf a Claim for payment is atkibutable to an instance in which Provider provided or roceived an
<br />incentive or kickback ln exchange for the referral, such Claim shall not be payable and, if paid in onor, shall
<br />be refunded to Wellpolnt.
<br />Netq-o.rk-s gnd Provider Panels. Provider shall be eligible to participate only in those Networks designated on
<br />the Provider Networks Attachment of thls Agreement. Provlder 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, standardi
<br />of participation and accreditation requirements. Provider acknowledges that Plan may develop, discontinue,
<br />or modifiy new or exlsllng Networks, products and/or programs. ln addltion to those Networks deslgnated on
<br />the Provider Networks Attachment, Wellpoint may also identlfo Provider as a Participating Provider in
<br />additional Netwoks, products and/or programs designated in writing from time to time by Wellpoint. The terms
<br />and conditions of Providefs particlpatlon as a Participating Provider ln such additional Networks, products
<br />and/or programs shall be on the terms and conditions as set forth in thls Agreement unless othenrulse agreed
<br />to in writing by Provider and Wellpoint.
<br />ln addltion to and separate from Networks that support some or all of Plan's products and/or programs (e.g.,
<br />HMO, PPO and lndemnlty products), Provlder further acknowledges that certain Health Services, includirg -by
<br />yay qf example only, laboratory or behavioral health services, may be provided excluslvely by designaieil
<br />Participating Providers (a "Health Servlces Designated Network"), as determined by Plan. Provider agrees to
<br />refer Members to such designated Participating Providers ln a Health Servlces Doslgnated Network for the
<br />provision of certaln Health Services, even if Provider performs such seMces. Notwithstanding any other
<br />provision in this Agreement, if Providor provides a Healttr Service to a Member for which Provider is not a
<br />deslgnated Participating Provider in a Health Services Designated Network, then Provlder 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 PIan,
<br />Chanoe in.Provider lnformatlon. Provlder shall lmmediately send written notice, in accordance with the Notice
<br />sectlon of thls Agreement, to Wellpoint of:
<br />2,12,'l Any legal, governmental, or other action or investigation involving Provlder whlch could affect
<br />Provider's credentialing status with Plan, or materially impair the ability of Provider to carry out
<br />hls/her/its duties and obligations under this Agreement, except for temporary emergency diversion
<br />sltuations; or
<br />2,12.2 Any change in Provider accreditation, affiliatlon, hospltal privileges (if applicable), insurance,
<br />licensure, certification or ellglbility status, or other relevant information regarding Provider's practice
<br />or status in the medical community.
<br />Washldgton Enterprlse Provlder Agrcemenl PCS
<br />@2024 July - Wellpolnt Washtnglon, lnc.5 1 1 839321 56
<br />05/0512025
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