Fully Executed Agreement (2) - Laserfiche WebLink

Home Browse Search

Docusign Envelope lD: 7 4E827C5-FAB8-8084-827C-41 4AD59920A6 2,8 Provider; (c) any convictions of Provider for uimes involving moral turpitude or felonies; and (d) any civil claim assefied against Provider that may jeopardize Provider's financial soundness. d, Stafting Privileges for Providers. Consistent with community standatds, every physician Provicler shall have staff privileges with at least one Health Plan contlacted hospital as necessary to provide services to members under this Agreoment and shall authorize each hospital at which he/she rnaintains staffprivileges to notify Health Plan should any disciplinary or other action of any kind be initiated against such provider which could result in any suspension, reduction or modification of his/her hospital privileges. e. Liability Insurance. Provider shall maintain premises and professional liability insurance in coverage amounts appropriate for the size and nature of Provider's facility and the nature of Plovideros health care activities. Every physician Provider shall maintain, at a minimum, professional tiability insurance with limits of not less thar $1 million per occurrence and $3 million in the aggregate for the policy year and for each physician comprising Provider. If the coverage is claims made or reporting, Provider agrees to purchase similar "tail" coverage upon tetmination of the Provider's present or subsequent policy. Provider shall deliver copies of such insurance policies to Health Plan within five (5) business days of a written request by Health Plan. Claims Payment. a. Submitting Claims. Provider shall promptly submit to Health PIan Claims for Covered Services rendered to Membem. All Claims shall be submitted in a form acceptable to and approved by Health Plan and shall include any and all medical records pertaining to the Claim if requested by Health Plan or otherwise required by Health Plan's policies and procedures. Claims rnust be subrnitted by Provider to Health Plan within tluee hundred sixty-five (365) days of providing the Covered Services that are the subject of the Claim. If Health Plan is not tfte primary payer under coordination of benefits, Provider must submit Claims to Health Plan within three hundred sixty-five (365) days from the primary payer's date of payment or date of contest, denial or nolice, Except as otherwise provided by law or provided by government sponsored program requirements, any Claims that are not submitted by Provider to Health Plan within the timelines stated above shall not be eligible for payment, and Provider heteby waives any right to payment, therefore. b, Compensation. Health Plan shall pay Provider for Clean Claims for Covered Services provided to Members, inclr.rding Emergency Services, in accordance with applicable law and regulations and in accordance with the compensation schedule set forth in Exhibit I and its applicable sub-exhibits. Provider shall accept such payment, applicable co-payments, deductibles, and coordination of benefits collections as payment in full for services provided under this Agreement. Provider shall not balance bill Members for any Covered Services, c. Co-paymcnt, Deductibles and Co-insurances. Ptovider is responsible for collection of co' paymenLs, deductibles and co-insurances, if any, provided for in the Member's Health Plan Product, d. Member Hold Harmless. i, Provider hereby agrees that in no event, including, but not limited to nonpayment by Health Plan, Health Plan's insolvency, or breach of this contract will Provider bill, charge, collect a deposit from, seek compensation, remuneration, of reimbursement from, or have any fecourse against a Member or person acting on their behal{ other than Health Plan" for seryices provided pursuant to this Agreement. This provision does not prohibit collection of deductibles, copayments, coinsuranse, andlor payrrent fcr noncovered services, which have not otherwise been paid by a primary or secondary issuer in accordance with regulatory standards for coordination ofbenefitso from Members in accordance with the terms of the Member's health plan. ii, Provider agrees in the event of Health Plan's insolvency to continue to provide the services promised in this Agreement to Members of Health Plan for the dnration of the period for which premiums on behalf of the Member were paid to Health Plan or until the Member's discharge from inpatient facilities, whichever time is greater. MI.IWPROV22.3 MHWPSA/Rsvised lan 2024 Page 9 of25