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Docusign Envelope lD: CEBC6B3C-DFA1-486C-AFE8-6A4A63440080 <br />D.O.; and Medi-Span@ Master Drug Data or any other nationally recognized drug database with <br />approval by HCA. <br />19. Claims Payment Standards. Except as otherwise allowed under Applicable Law, or <br />unless otherwise agreed by the Parties in writing on a claim-by-claim basis, CHPW shall meet <br />the following minimum standards for timeliness of payment: ninety-five percent (95%) of Clean <br />Claims shall be paid or denied within thirty (30) calendar days of receipt of the paper or <br />electronic claim; ninety-five percent (95%) of all claims shall be paid or denied within sixty (60) <br />calendar days of receipt of the paper or electronic claim; and ninety-nine percent (99%) of Clean <br />Claims shall be paid or denied within ninety (90) calendar days of receipt. <br />20. Appointment Wait Time Standards. As applicable, Facility shall meet the following <br />appointment wait time standards with respect to Members: <br />20.I Transitional healthcare services by a PCP shall be available for clinical <br />assessment and care planning within seven (7) calendar days of discharge from inpatient or <br />institutional care for physical or behavioral health disorders or discharge from a Substance Use <br />Disorder treatment program. <br />20.2 Transitional healthcare services by a home care nurse, a home care Mental Health <br />Professional or other Behavioral Health Professional shall be available within seven (7) calendar <br />days of discharge from inpatient or institutional care for physical or behavioral health care, if <br />ordered by the Member's PCP or as part of the discharge plan; <br />20.3 Preventive care office visits shall be available from the Member's PCP within <br />thirly (30) calendar days; <br />20.4 Routine care office visits shall be available from the Member's PCP within ten <br />(10) calendar days, including behavioral health services from a behavioral health provider; <br />20.5 Urgent, symptomatic office visits shall be available from the Member's primary <br />care, behavioral health or another provider within twenty-four (24) hours; <br />20.6 Emergency medical care shall be available twenty-four (24) hours per day, seven <br />(7) days per week; and <br />20.7 Second opinion appointments specifically described in the State Contract must <br />occur within thirty (30) calendar days of the request, unless the Member requests a postponement <br />of the second opinion to a date later than thirry (30) calendar days. <br />CHPW shall monitor Facility's compliance with this Section. In the event Facility fails to comply <br />with the applicable appointment wait time standards set forth in this Section, Facility shall comply <br />with CHPW's procedures for corrective action. Nothing in this Section prohibits Facility from <br />conducting assessments in alternate settings, such as the Member's home or within an institutional <br />setting. <br />21. 24/7 Availability. To the extent applicable, Facility shall make the following services <br />available twenty-four (24) hours per day, seven (7) days per week, three hundred sixty-five (365) <br />days a year by a toll-free telephone number: <br />2020 Facility Exh BIB - McaidProv Page 34 of51 Contract #5908-662684