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Docusign Envelope lD: 7 4E827C5-FAB8-8084-827C-41 4AD59920A6 15 h. These standards do not apply to Claims about which there is substantial evidence of fraud or misrepresentation by Prcviders, facilities or Members, or instances where Health Plan has not been granted reasonable aocess to information under Providerns control' i. Health PIan and Plovider are not required to comply with these tetms and conditions of payment if the failure to comply is occasioned by any act of God, bankruptcy, act of a governmental authority responding to an act of God or other emergency, or the result of a strike, lockout, or other labor dispute. Notwithstanding any other provision of this Agreement, Provider is not required to grant Health Plan access to health information and other similar records unrelated to Members, This provision shall not limit Health Plan's right to ask for and receive information relating to the ability of Provider or facility to deliver health care services that meet the accepted standards of medisal care prevalent in the community, Notwithstanding any other provision of this Agreement, any access Provider must graut Health Plan to medioal records for audit purposes must be limited to only that necessary to perform the audit. Provider maintains a reciprocal right to audit Health Plan's denials of Provider's Claims when Health Plan audits Provider's Claims. In the event Provider participates in Health Plan's Medicare Programs, the following provisions shall apply: a, Provider shall make all of its "Relevant Records" available for inspeotion, examination and copying by all federal and state agencies with regulatory authority over the subject matter of this Agreement, Provider shall permit such inspection at Provider's place of business and at all reasonable times. o'Relevant Records" shall mean all books and records of Provider related directly or indirectly to the goods and services furnished under the terms of this Agreement. Provider shall nraintain such Relevant Records for the period of time required by applicable federal and state statutes, but in no event less than ten (10) years. This provision shall survive termination of the Agreement. (42 CFR 422.s04(e)(2),422.504(e)(3>,422.s04(e)(4),and422^s04(ix2xii). b. Provider shall comply with the confidentiality and enrollee record accuracy requirements set forth in 42 CFR 422.118, (42 CFR a22.s0a@)(3)). c. Provider agrees that under no circumstance shall a subscriber or eruollee in Health Plan's Medicare Programs be liable to the Provider for any sums owed by Health Plan to Provider. (42 CFR a22.s04(s)(1Xi) and 42 CFR 422.s04(D(3Xi)). d. If Provider is delegated any of the activities or functions of Health Plan as required in its contract with CMS, Provider agrees to comply with all applicable contractual provisions in the same manner as if Provider had executed such contract with CMS directly, The activities or functions clelegated to Provider are set forth in the Agreement. In the event CMS or Health Plan determines, in its sole discretion, that Provider has not performed the delegated activities or functions satisfactorily, the delegated activities shall be revolced upon not less than five (5) days prior wdtten notice. The performance of such delegated activities shall be monitored by Health Plan on an ongoing basis, and Provider shall cooperate with all reasonable requests made by Health Plan in order to accomplish such monitoring. If Provider is delegated credentialing activities, Provider's credentialing process will be reviewed and approved by Health Plan, and sucli credentialing process will be audited by Health Plan on an ongoing basis; further, Provider agrees that its credentialing process will comply with all app I icable NCQA standards. (42 CFR 422. 5 04 (ix3xiii) and 422.504(D(4)). e. Provider agrees that any services it performs will be consistent with and comply with Health Plan's contractual obligations with CMS, (42 CFR 422,504(iX1) and 422.504(iX3XiiD). tl In the event of termination of this Agreement or Health Plan's insolvency, Provider agrees to comply with the continuation of benefits provisions included in the Provider Manual. (42 CFR a22s\a@)QD. 16. 17 18 M[{WPROV22.3 MHWPSA,/Revis ed lan 2024 Page 20 of25