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3.2
<br />3.3
<br />3.4
<br />3.6
<br />3.5
<br />disclosure or transfor of proprletary or confidential informailon by Provider or Wellpoint will be ln accordance
<br />with applicable Regulatory Requirements. Provldor shall immediately notifi Wellpolnt if Provider ls requlred
<br />to disclose any proprietary or confidential information at the request of an Agency or pursuant to any federal
<br />or state freedom of informatlon act request.
<br />9onfidentia,ljty qf Mgm9,et lnformation. Both parties agree to comply wlth the Health lnsurance Portability and
<br />Accountabillty Act of ',l996 ("HlPAA") and the Health lnformation Technology for Economic and Cllnical Fiealth
<br />Act ("HITECH {ct"), and as both may be amended, es well as any other applicable Regulatory Requirements
<br />regarding confldentlality, use, disclosure, security and access of the Member's personally ldentlflable
<br />information ("Pll") and protected health information ("PHl"), (collectively "Member lnformation"). Provider shall
<br />review all Member lnformation received from Wellpoint to ensure no misrouted Member lnformation ls
<br />included. Mlsrouted Member lnformation lncludes but is not llmited to, information about a Member that
<br />Provider is not currently treating. Provlder shall lmmedlately destroy any misrouted Member lnformalion or
<br />safeguard the Member lnformation for as long as it is retained. ln no event shall Provider be permitted to
<br />misuse or re-disclose misrouted Membor lnformatlon. lf Provider cannot destroy or safeguard misrouted
<br />Member lnformation, Provider must contact Wellpoint to report receipt of misrouted Member lnformation.
<br />Nptwot Prol/ider/Patient Dlscussions. Notwithstanding any other provision ln this Agreement and regardless
<br />of any benefit or covsrage excluslons or limltations associated with a Health Beneftt Plan, Provider shall not
<br />be prohibited from dlscussing fully with a Member any lssues related to the Member's health lncluding
<br />recommended treatments, troatment alternatives, treatment risks and the consequences of any benefrt
<br />coverage or payment decisions made by Plan or any other party. ln addition, nothing in this Agreement shall
<br />be construed to, create any financial incentive for Provider to withhold Covered Servlces, or prohibit Provider
<br />from disclosing to the Member the general methodology by which Provider is compensated undor this
<br />Agreement, such as for example, whether Provider is paid on a fee for service, capltation or Percentage Ratebasis, Plan shall not refuse to allow or to continue the participation of any otherwise eligible provlder, or
<br />refuse to compensate Provider in connection with sorvlces rendered, solely because Provider has in good
<br />hlth communicated with one or more of his/her/its current, former or prospective pa0ents rogarding the
<br />provisions, terms or requirements of a Health Bsnefft Plan as they relate to the health needs of such patient,
<br />Nothing in thls section shall be construed to permit Provider to disclose Wellpoint Rates or specilic terms of
<br />the compensation arrangement under this Agreement.
<br />Plan AcceFs,to and Requests for Provider Records. Provider and its designees shall comply with all applicable
<br />state end federal record keeping and retention requirements, and, as set forth in the provider manual(s) and/or
<br />Partlcipation Attachment(s), shall permit Plan or its designees to have, with appropriate working space and
<br />without charge, on-site access to and the right to perform an Audit, examine, copy, excerpt and fanscribe any
<br />books, documents, papers, and records related to Merrber's medical and bllling information within the
<br />possession of Provider and lnspect Provider's operations, which involve transactions relating to Members and
<br />as may be reasonably required by Plan in carrying out its responsibilities and programs including, but not
<br />limited to, assesslng quality of care, complying with quality initiativesimeasures, Medical Necesslty, cbncurrent
<br />review, appropriateness of care, accuracy of Claims coding and payment, risk adJustment assessment as
<br />described in tho provider manual(s), including but not limited to completion of the Eniounter Facllibtion Form
<br />(also called the "SOAP' note), compliance with thls Agreement, and for research. ln lieu of on-site access, at
<br />Plan's request, Provider or its designees shall submit records to Plan, or its designees vla photocopy or
<br />electronic transmittal, wlthin thirty (30) days, at no charge to Plan from either Provider or its designee. Provider
<br />shall make such records available to tho state and federal authorities involved in assessing quality of care or
<br />lnvestigating Member grievances or complaints in compliance with Regulatory Requiroments. Provider
<br />acknowledges that failure to submit rec.ords to Plan ln accordance wlth this provision and/or the provider
<br />manual(s), and/or Participation Attachment(s) may result in a denial of a Clalm under review, whether on pre-
<br />payment or post-payment revlew, or a payment retraction on a paid Claim, and Provider ls prohibited from
<br />balance billing the Member in any of the foregoing circumstances.
<br />Transfer of Medical Records. Following a request, Provider shall transfer a Member's medical records ln a
<br />timoly manner, or within such other time period required under applicable Regulatory Requirements, to other
<br />health care providers teatlng a Member at no cost to Wellpoint, Plan, the Member, or other treating health
<br />care providers.
<br />9linical Data Sharing. Wellpoint and Provlder desire to collaborate by sharing data, including Member
<br />lnformation, to enhance certain health care operations activities, prlmarily to help improve quality and
<br />efficiency of health care. Each party's access to better clinical and administrative data is critical to the mutual
<br />goal of Wellpoint and Provider improving health care quality as it relates to their respective Members and
<br />patlenls. Therefore and upon request, Provlder agrees to provide data to Wellpoint for troatment purposes,
<br />Washlngton Enterpriso Provld€r Agreemonl PCS
<br />@ 2024 JuIy - Wellpohl Wa6t{ngton, lnc.7 1'183932156
<br />05i052025
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