SHJ25-014 MOLINA HEALTHCARE RENEWAL - PARTIALLY EXECUTED

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information as requested by Health Plan and/or as required by any governmental agency or any appropriate state and federal authority having jurisdiction over Health Plan. e. Member Access to Health Information. Provider shall give Health Plan and Members access to Members' health information including, but not limited to, medical records and billing records, in accordance with Laws, applicable government sponsored health programs, and Health Plan's policies and procedures. f. National Provider Identifier ("NPI"). In accordance with applicable statutes and regulations of HIPAA Provider will comply with the Standard Unique Identifier for Health Care Provider regulations promulgated under HIPAA (45 CFR Section 162.402, et seq.) and use only the NPI to identify HIPAA covered health care providers in standard transactions. Provider will utilize an NPI from the National Plan and Provider Enumeration System ("NPPES") for itself or for any subpart of the Provider. Provider will make best efforts to report its NPI and any subparts to Health Plan. Provider will report any changes in its NPI or subparts to Health Plan within thirty (30) days of the change. Provider will use its NPI to identify itself on all Claims and encounters (both electronic and paper formats) submitted to Health Plan. 2.6 Program Participation. a. Participation in Grievance Program. Provider shall participate in Health Plan's Grievance Program and shall cooperate with Health Plan in identifying, processing, and promptly resolving all Member complaints, grievances, or inquiries. b. Participation in Quality Improvement Program. Provider shall participate in Health Plan's Quality Improvement Program and shall cooperate with Health Plan in conducting peer review and audits of care rendered by Provider. c. Participation in Utilization Review and Management Program. Provider shall participate in and comply with Health Plan's Utilization Review and Management Program or the utilization review and management program of Health Plan's designee, including all policies and procedures regarding prior authorizations, and shall cooperate with Health Plan or Health Plan's designee in audits to identify, confirm, and/or assess utilization levels of Covered Services. If Provider is a medical group or IPA, Provider shall accept delegation of utilization management responsibilities from Health Plan at Health Plan's request. d. Participation in Credentialing. Provider shall participate in Health Plan's credentialing and re- credentialing process and shall satisfy, throughout the term of this Agreement, all credentialing and re-credentialing criteria established by the Health Plan. Provider shall immediately notify Health Plan of any change in the information submitted or relied upon by Provider to achieve credentialed status. If Provider's credentialed status is revoked, suspended, or limited by Health Plan, Health Plan may at its discretion terminate this Agreement and/or reassign Members to another provider. If Provider is a medical group or IPA, Provider shall accept delegation of credentialing responsibilities at Health Plan's request and shall cooperate with Health Plan in establishing and maintaining appropriate credentialing mechanisms within Provider's organization. e. Provider Manual. Provider will follow the terms set forth in Health Plan's Provider Manual, which may be amended from time to time at Health Plan's sole discretion. Provider shall comply and render Covered Services in accordance with the contents, instructions and procedures set forth in Health Plan's Provider Manual and any additional operating procedures and policies for Providers which are communicated to Provider in writing by Health Plan. Provider acknowledges it received Health Plan's Provider Manual. f. Government Contracts. Provider acknowledges that Health Plan has entered into contracts with state and federal agencies for the arrangement of health care services for Members through government sponsored programs. Provider shall comply with any term or condition of those government sponsored program contracts that are applicable to the services to be performed under this Agreement. MIIWPROV22.3 MHWPSA/Revised Jan 2024 Page 7 or25