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2.13
<br />2.14
<br />2.15
<br />2.16
<br />2.17
<br />2.18
<br />2_19
<br />2.20
<br />3.1
<br />Provlder Credentiallng. $tandardq-sf Particlpation and Accreditation, Provider warrants that he/shelit meets
<br />all applicable Plan credentialing requirements, standards of partlclpation, and accreditatlon requirements for
<br />the Networks in which Provider partlclpates. A description of the applicable credentialing iequirements,
<br />standards of participation, and accreditation requirements, are set forth in the provider manual(s) and/or in the
<br />PCS. Provjder acknowledges lhat until such time as Provider has been determlned to have fulty met Plan's
<br />credentialing requirements, standards of participation, and accredltation requirements, as applicable, Providor
<br />shall not be entitled to the beneflts of participation under this Agreement, lncluding without limitation the
<br />Wellpoint Rates set forth in the PCS attached hereto,
<br />Provlder. Staffinq and Staff Privileges, Provider agrees to maintain professional staffing levels to meet
<br />community acc€ss standards and where appllcable, agrees to facilitate and to expeditiously grant admitting
<br />prlvileges to Participatlng Providers who meet Provider's credentiallng standards.
<br />Adiustment Roouestq. lf Provider believes a Claim has been improperly adjudicated for a Covered Servlce for
<br />which Provider timely submitted a Claim to Plan, Provlder must submit a request for an adlustment to Plan in
<br />accordance with the provider manual(s).
<br />Provislon and Supervi$ion of Services. ln no way shall Wellpoint or Plan be construed to be providers of Health
<br />Services or responsible for, exercise control, or have direction over the provision of such Health Sorvlces,
<br />Provider shall be solely responsible to the Member for treatment, medical care, and advice with respect to the
<br />provision of Health Services. Provider agrees that all Health Services provided to Members under this
<br />Agreement shall be provided by Provideror by a qualified person under Provider's dlrection. Providerwarrants
<br />that any nurses or other health professionals employed by or providing services for Provider shall be duly
<br />licensed or certified under applicable law. ln addltion, nothing herein shall be construed as authorlzlng or
<br />permlttlng Provider to abandon any Member.
<br />9oordinatiQn of Bgnefits/Subrooation. $ubject to Regulatory Requiroments, Provider agrees to cooperate with
<br />Plan regarding subrogation and coordination of benefits, as set forth in Policios and the provlder manual(s),
<br />and to notiff Plan promptly afterreceipt of lnformation regardlng any Memberwho may have a Glaim involving
<br />subrogation or coordination of beneffts.
<br />Cogt Effective Care. Provider shall provide Covered Services in the most cost effective, clinically appropriate
<br />setting and manner. ln addition, in accordance with the provlder manual(s) and Policies, Provider shall irtlllze
<br />Particlpating Providers, and when Medically Necessary or appropriate, refer and transfer Members to
<br />Partldpating Provlders for all Covered Services, including but not limited to specialg, laboratory, ancillary and
<br />supplemental services.
<br />Facilifu'Based Providers. Provider agrees to require its contracted facillty-based providers or those with
<br />exclusive prlvileges with Provider to obtain and maintaln Partlclpating proviOer staius with Wellpoint. Until
<br />such lime as facillty-based providers enter into agreements with Wellpolnt, Provider agrees to fully cooperate
<br />wlth Wellpoint to prevent Members from being billed amounts in excess of the applicable Wellpoint non-
<br />partlclpating reimbursement for such Covered Services. Facility-based providers may include, but are not
<br />limited to, anesthesiologists, radiologlsts, pathologists, neonatologists, hospitalists and emergency room
<br />physicians.
<br />Digit€l Guidelines. Provider shall comply with the Dlgltal Guidelines set forth in the provider manual(s).
<br />ARTIGLE III
<br />CONFIDENTIALITY/RECORDS
<br />Proprietarv and Confidentifll lnformatlon. Except as othenrulse provided herein, all lnformation and material
<br />provided by elther party in contemplation of or in connection with this Agreement remains proprletary and
<br />confidential to the disclosing party. Thls Agreement, including but not limited to the Wellpoint Rates, is
<br />Wellpoint's proprietary and confidential information. Neither party shall dlsclose any lnformaiion proprletary
<br />or confidential to the other, or use such lnformatlon or material except: (1) as otherurise set forth in tni6
<br />Agreement; (2) as may be required to perform obligations horeunder; (3) as required to deliver Health Services
<br />or administor a Health Bonefit Plan; (4) to Plan or its designees; (5) upon the express written consent of the
<br />partles; or (6) as required by Regulatory Requirements. Notwithstanding the foregoing, either pafi may
<br />disclose such information to its legal advisors, lenders and buslness advisors, provided that such bgdl
<br />advisors, lenders and businoss advlsors agroe to malntain confidentiallty of such information. Provider and
<br />Wellpoint shall each have a system in place that meets all appllcable Regulatory Requirements to protect all
<br />records and all other documents relating to this Agreement which are deemed confidential by law. Any
<br />Washlnglon Enterpriso Provldor Agreement PCS
<br />o 2024 July- Wollpdnt Washlngton, lnc.6 '1183932156
<br />05/0612025
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