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Docusign Envelope lD: CEBCOB3C-DFA1-4BOC-AFE8-6A4A63440086 <br />1.10.4 is not experimental or investigative; <br />1.10.5 is consistent with good medical practice; <br />1.10.6 is not provided primarily for the convenience of the Member, provider or Facility; and <br />I.I0.7 is the most cost-effective of the alternative levels of service or supplies that are <br />adequate and available. <br />L.11 "Member" is an individual enrolled in a Benefit Plan and entitled to receive Covered <br />Services pursuant to that Benefit Plan. <br />1.12 'Non-Participating Provider" means a professional health care provider, facility or legal <br />entity that does not have a written agreement with CHPW to participate in its Provider Network <br />andlor has not been credentialed by CHPW but may provide health care services to Members <br />upon referral and prior authorization. <br />1.13 "Participating Provider" means an individual healthcare practitioner, facility or legal entity <br />that is duly licensed, certified and/or registered by the appropriate state or other governmental <br />board or agency, is credentialed by CHPW or its delegate, and under a written agreement with <br />CHPW that is current at the time Covered Services are rendered is authorized to provide Covered <br />Services to Members. Participating Providers are collectively referred to as CF{PW's "Provider <br />Network". <br />1.14 "Primary Care Provider" means a Participating Provider who is responsible for (i) providing <br />primary health care, (ii) initiating referrals for specialist and inpatient care, and (iii) supervising, <br />coordinating and maintaining continuity of Members' health care. <br />l.l5 "Provider Manual" refers to applicable CHPW manuals, policies and procedures, and <br />documents, as periodically revised, including those that refer to Program Integrity requirements, <br />credentialing, utilization management, prior authorization requirements, claims and encounter <br />submission, payment, drug formulary, and Participating Provider lists. The Provider Manual <br />and associated information are available to Facility online through www.CHPW.org. <br />1.16 "Service Area" means those geographic areas in which CHPW is contracted to provide <br />Covered Services to Members. <br />il. OBLIGATIONS OF FACILITY <br />2.1 Engagement. CFIPW hereby engages Facility to participate in CHPW's Provider Network, <br />and Facility hereby accepts such engagement pursuant to the terms and conditions hereunder. <br />2.2 Facility License, Accreditation and Participation. <br />2.2.1Facility shall be licensed by the state in which it provides services hereunder. <br />2020 F acihty Agmt - Template Page 3 of51 Contract #5908-662684