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3.23. Release of Necessary Information. Provider acknowledges and agrees to release to Health Plan any information necessary to perform any of Hoalth Plan's obligations under the State Contract, 3.24. Encounter Data Reportine. Provider shall submit complete, accurate and timely encounter data and behavioral health supplemental transacfions to Health Plan in accordance with current encounter submission guidelines published by HCA or as otherwise specified by Health Plan. Provider represents and warrants that it has the capacity to submit all data required by HCA to enable Health Plan to meet the reporting requirements in the Encounter Data Reporting Guide and Service Encounter Data Re,porting Guide (SERI) and Behavioral Health Supplemental Transaction Data Guide published by I{CA, 3.25. Potential Aliegations of Fraud. Provider shall refer potential allegations of fraud to HCA and the Medicaid Fraud Control Unit as described in Subsection 12.6 of the State Contuact. 3,26. Fraud. Waste..And Abuse. Provider shall comply with Health Planos policies regardingfraud, waste and abuse. In addition, Provider shall comply with the following applicable provisions necessary to prevent fraud, waste and abuse. (a) IfProvider is delegatedresponsibilityforcoverageofservices andpayrnent ofclairnsunder the State Contraol; then Provider shall implement and maintain administrative and management arrangements or procedures designed to detect and prevort fraud, waste and abuse that are consistent with Health Plan's policies and all requiremEnts of applicable law and the State Contract, inclucling without limitation those described in Section 12.5.1 of the State Confract. (b) Provider shall (i) provide written disclosure of any prohibited affiliation in acsordance with 42 C.F.R. $ 438.610; 42 C,F.R $ 455.106; and 42 C.F,R $ 438.608(c)(1) to HCA; (ii) provide written disclosures of infonnation on ownership and control as indicated under SubsectionI2.3 of the State Contract (42 C.F.R, g 455.104; 42 C.F.R. $ 455.105; and" 42 C,F,R $ a38.608(c)(Z)); (iii) maintain intonal policies and procedures for the documentation, retention, and recovery of a1l overpayments, specifically for the recov€ry of overpayments due to fraud, waste or abuse, consistent rvith the State Conhact; and (iv) report to Health Plan and HCA within 60 calendm days when it has identified capitation payments or other payment amounts received are in excess to the amounts specifled in the State Contract (42 C.F.R. $ a38,608(c)(3)). (c) Provider shall cooperate with Health Plan audits of Provider to detect and identify fraud, waste and abuse. 3.27 . Subrosation. Provider agrees to subrogate to the State for ali sriminal, civil and administrative action recoveries undertaken by any government entity, including, but not limited to, all claims ProvidEr has or may have against any entity or individual that directly or indirectly receives funds under the State Contract including but not limited to, any health care provider, manufaoturer, wholesale or reiail supplier, sales representative, laboratory, or other provider in the design, manufachrre, marketing, pricing, or quality of drugs, pbarmac.euticals, medical supplies, medical devices, durable medical equipment, or other health eare related products or services. For the purposes of this section, "subrogation'' means the right of any State government entity or local law enforcement to stand in the plaoe of Provider in the collection against a third parfy. 3.28. Limitations on Referrals. Provider reftrrals may be limited to Participating Providers except in the following circumstances: (a) emergency services; (b) services provided outside the Service Areas as necessary to provide Medically Necessary sorvioes; (c) when a Covered Person has other primary comparable physical and/or behavioral health coverage, as necessary to coordinate benefits; and (d) within the Service Areas, as defined in the Servioe Areas provisions of the Enrollment Section of the State Contrac! Provider shall cover Covered Persons for allphysical and/or behavioral healih necessary services. 3.29. Hieh Categorical Risk Providers. Providers that are deemed to be "high categorical risk," including PPA WA - Kittitas County Pubtic H ealth - 05 .07 .2V25 - ICMProviderAgreement_3 60268 P age 6 of 12