Common use of DUTIES AND RESPONSIBILITY OF RHS Clause in Contracts

DUTIES AND RESPONSIBILITY OF RHS. 2.1 Administrative Procedures: RHS shall make available to Primary Care Provider administrative procedures and duties under this Agreement. RHS shall provide to Primary Care Provider appropriate training developed by RHS as periodically updated. All procedures relating to the foregoing shall be contained in the RHS Provider Manual. RHS shall provide the necessary resources to appropriately administer Covered Services. RHS and/or Healthcare Plan(s) has the sole responsibility and final decision making authority for: (i) payment of claims for health services rendered to Members; (ii) eligibility of enrollment in Healthcare Plan; (iii) termination of a Member’s coverage under the Healthcare Plan; (iv) all benefit determinations; and (v) the Provider and Member grievance system established by RHS and Healthcare Plan(s). RHS agrees to recognize and abide by all state and federal laws, regulations and guidelines. RHS has not delegated any administrative duties to Primary Care Provider unless expressly set forth herein and only to the extent set forth herein.

DUTIES AND RESPONSIBILITY OF RHS. 2.1 Administrative Procedures: RHS shall make available to Primary Care Specialty Provider administrative procedures and duties under this Agreement. RHS shall provide to Primary Care Provider specialty provider appropriate training developed by RHS as periodically updated. All procedures relating to the foregoing shall be contained in the RHS Provider Manual. RHS shall provide the necessary resources to appropriately administer Covered Services. RHS and/or Healthcare Plan(s) has the sole responsibility and final decision making authority for: (i) payment of claims for health services rendered to Members; (ii) eligibility of enrollment in Healthcare Plan; (iii) termination of a Member’s coverage under the Healthcare Plan; (iv) all benefit determinations; and (v) the Provider and Member grievance system established by RHS and Healthcare Plan(s). RHS agrees to recognize and abide by all state and federal laws, regulations and guidelines. RHS has not delegated any administrative duties to Primary Care Specialty Provider unless expressly set forth herein and only to the extent set forth herein.