Common use of Provider Obligations Clause in Contracts

Provider Obligations. 5.1 Provider agrees to transmit Transactions through the CHC Services only in accordance with the requirements, procedures, data element standards, formats, codes, protocols and edits set forth in the then applicable CHC Specifications. 5.2 Provider shall promptly report to CHC any performance problems related to the CHC Products and the CHC Services, including a description of the circumstances surrounding their occurrence. 5.3 Provider shall execute any and all documents and comply with any and all applicable procedures, rules and regulations which CHC, the applicable Payer, or applicable law may require for transmission by CHC of Transactions to such Payer’s system, including without limitation, rules governing record retention, non-discrimination, and error resolution as promulgated by the CHC Services, American Express, MasterCard, VISA, the settlement bank, and insurance carriers, each as amended from time to time. Provider also shall adhere to such rules and regulations as are required by governmental agencies having jurisdiction, including the Department of Health and Human Services (“HHS”). Provider shall provide all supporting documents requested by CHC necessary to comply with said rules and regulations. In furtherance thereof, CHC is required to pass on and/or obtain the following covenants from Provider relating to eligibility Transactions with Medicaid programs: (a) access to eligibility information shall be restricted to the sole purpose of verification of Medicaid eligibility where Medicaid payment for medical services has been requested by authorized parties or where otherwise permitted by federal or state statute or regulation; (b) verification of eligibility under the system is not a guarantee of payment and the records as to the recipient’s eligibility status shall be the final authority; (c) Provider indemnifies and holds harmless each State, its agents and employees, from any and all claims by such Provider or any recipient who is aggrieved by the actions of Provider hereunder; and (d) Customer is an approved Medicaid provider in each State to which it submits eligibility Transactions, and has supplied its correct Provider Identification Number for each such State on the signatory page hereto; and (e) Provider agrees to abide by the Federal and State regulations regarding confidentiality of information. 5.4 Provider hereby appoints CHC as its attorney-in-fact for the limited purpose of using the information Provider provides to submit electronic Transactions and/or sign hard copy (paper) Transactions on Provider’s behalf to third- party Payers or processors, including but not limited to commercial insurers, Medicare, Medicaid, and government agencies, and, where appropriate, agencies or carriers covering work-related accident or illness benefits where Provider’s signature is required for Transaction processing. Provider acknowledges that CHC is not responsible for the content or adjudication of any Medicare, Medicaid, work-related accident or illness claim or other insurance claim, and Provider retains all liability on such claims and agrees to indemnify and hold CHC harmless on account of all such claims, including the reconciliation or adjustment of any claim. 5.5 Provider shall guarantee that all Transactions submitted to the CHC Services by Provider will be on behalf of physicians or suppliers that have executed appropriate written authorizations for such submission, and a true copy of such authorization shall be furnished to CHC upon request. Provider also shall guarantee that each claim shall be maintained by Provider for a period of seventy-two (72) months in such manner as to assure that such claim can be associated or identified with a claim form from the applicable physician or supplier. 5.6 Provider shall retain records relative to Provider’s use of the CHC Services in accordance with sound business practices, and CHC may request access during normal business hours upon reasonable advance prior notice to such records as are reasonably necessary to examine Provider’s compliance with its obligations hereunder. Provider shall use these services for dental purposes only.

Provider Obligations. 5.1 A. Provider agrees represents and warrants that all provisions of Section 5, Provider Obligations, and Schedule 1, attached hereto and incorporated into this Addendum, shall apply equally to transmit Transactions through the CHC Services only in accordance with the requirementsany employee, procedurestemporary employee, data element standardspartner, formats, codes, protocols and edits set forth in the then applicable CHC Specifications. 5.2 Provider shall promptly report to CHC any performance problems related or other individual practitioner that performs services under this Medicare Addendum to the CHC Products and the CHC Services, including a description of the circumstances surrounding their occurrence. 5.3 Provider shall execute any and all documents and comply with any and all applicable procedures, rules and regulations which CHC, the applicable Payer, or applicable law may require for transmission by CHC of Transactions to such Payer’s system, including without limitation, rules governing record retention, non-discrimination, and error resolution as promulgated by the CHC Services, American Express, MasterCard, VISA, the settlement bank, and insurance carriers, each as amended from time to time. Provider also shall adhere to such rules and regulations as are required by governmental agencies having jurisdiction, including the Department of Health and Human Services (“HHS”). Provider shall provide all supporting documents requested by CHC necessary to comply with said rules and regulations. In furtherance thereof, CHC is required to pass on and/or obtain the following covenants from Provider relating to eligibility Transactions with Medicaid programs: (a) access to eligibility information shall be restricted to the sole purpose of verification of Medicaid eligibility where Medicaid payment for medical services has been requested by authorized parties or where otherwise permitted by federal or state statute or regulation; (b) verification of eligibility under the system is not a guarantee of payment and the records as to the recipient’s eligibility status shall be the final authority; (c) Provider indemnifies and holds harmless each State, its agents and employees, from any and all claims by such Provider or any recipient who is aggrieved by the actions of Provider hereunder; and (d) Customer is an approved Medicaid provider in each State to which it submits eligibility Transactions, and has supplied its correct Provider Identification Number for each such State on the signatory page hereto; and (e) Provider agrees to abide by the Federal and State regulations regarding confidentiality of information. 5.4 Provider hereby appoints CHC as its attorney-in-fact for the limited purpose of using the information Provider provides to submit electronic Transactions and/or sign hard copy (paper) Transactions on Provider’s behalf to third- party Payers or processorsAgreement, including but not limited to commercial insurersthose employees, Medicaretemporary employees, Medicaidpartners, and government agencies, and, where appropriate, agencies or carriers covering work-related accident or illness benefits where other individual practitioners who perform services under this Agreement in Provider’s signature is required for Transaction processing. Provider acknowledges that CHC is not responsible for the content or adjudication of any Medicare, Medicaid, work-related accident or illness claim or other insurance claim, and Provider retains all liability on such claims and agrees to indemnify and hold CHC harmless on account of all such claims, including the reconciliation or adjustment of any claim. 5.5 Provider shall guarantee that all Transactions submitted to the CHC Services by Provider will be offices on behalf of physicians or suppliers that have executed appropriate written authorizations Provider for which Provider bills such submissionservices under this Agreement. Provider shall take all steps necessary to cause such individuals described in this section to comply with this Addendum, including Schedule 1, and a true copy all applicable laws, regulations and CMS instructions. Provider represents and warrants that Provider has the authority to bind such individuals, and shall provide written evidence of such authorization shall be furnished to CHC the same upon request. Provider also represents and warrants that all provisions of this Addendum, including Schedule 1, shall guarantee that each claim apply equally to any of Provider’s Downstream Entities, as defined by CMS and as set forth in Schedule 1 to this Addendum. Provider shall include in Provider’s contracts with Downstream Entities all of the contractual and legal obligations required by Company in order for the Downstream Entity and Company to comply with applicable laws, regulations and CMS instructions. Provider shall take all steps necessary to cause its Downstream Entities to comply with this Addendum, including Schedule 1, and all applicable laws, regulations and CMS instructions. To the extent CMS requires additional provisions to be maintained by Provider for a period of seventy-two (72) months included in such manner as to assure that such claim can be associated or identified subcontracts, Provider shall amend its contracts with a claim form from the applicable physician or supplierits Downstream Entities accordingly. 5.6 B. Provider shall retain records relative agrees to Providerprovide to Company’s use of Medicare Members the CHC Services health care services for which Provider is licensed and customarily provides in accordance with sound business practicesaccepted medical and surgical standards in the community. Provider shall make such Covered Services available and accessible to Company’s Medicare Members, including telephone access to Provider, on a twenty-four (24) hours, seven (7) days per week basis. Provider agrees to provide to Company those services, as described in the Agreement, that support Company’s Medicare Plans, including but not limited to the health care services described in this Section (“Medicare Services”). Provider acknowledges and CHC agrees that Company may request access during normal business hours upon reasonable advance prior notice monitor the performance of Provider to such records as are reasonably necessary to examine confirm Provider’s compliance with its applicable laws, regulations and CMS instructions. C. Provider agrees that all Medicare Services performed by Provider under the Agreement will be consistent and comply with Company’s obligations hereunderas a Medicare Advantage Organization under Company’s contracts with CMS. Upon request, Provider shall use these services for dental purposes onlyimmediately provide to Company any information that is required by Company to meet its reporting obligations to CMS, including without limitation, physician incentive plan information, if applicable. ▇. ▇▇▇▇▇▇▇▇ agrees to cooperate with and participate in internal and external review procedures necessary to allow Company to process Medicare appeals and grievances in accordance with Medicare laws, regulations and CMS instructions.

Provider Obligations. 5.1 Provider agrees to transmit Transactions through the CHC ENVOY Services only in accordance with the requirements, procedures, data element standards, formats, codes, protocols and edits set forth in the then applicable CHC relevant Specifications. Provider acknowledges and agrees that ENVOY may charge Provider a fee of 25 cents for each Transaction rejected by ENVOY or a Payer for noncompliance with the foregoing Provider obligations in excess of 3% of Provider’s Transaction volume for any month after 90 days following the date of this Agreement. 5.2 Provider shall promptly report to CHC any performance problems related to the CHC Products and the CHC Services, including a description of the circumstances surrounding their occurrence. 5.3 Provider shall execute any and all documents and comply with any and all applicable procedures, rules and regulations which CHCENVOY, the applicable Payer, or applicable law may require for transmission by CHC ENVOY of Transactions to such Payer’s system, including without limitation, rules governing record retention, non-discrimination, and error resolution as promulgated by the CHC ENVOY Services, American Express, MasterCard, VISA, the settlement bank, and insurance carriers, each as amended from time to time. Provider also shall adhere to such rules and regulations as are required by governmental agencies having jurisdiction, including the Department of Health and Human Services (“HHS”). Provider shall provide all supporting documents requested by CHC ENVOY necessary to comply with said rules and regulationsregulations including The Secretary of Health and Human Services (the “HHS Secretary”), the Electronic Funds Transfer Act, Regulation 2, Regulation E and the Federal Truth-in-Lending Act. In furtherance thereofhereof, CHC ENVOY is required to pass on and/or obtain the following covenants from Provider relating to eligibility Transactions with Medicaid programsProvider: (a) access to eligibility information shall be restricted to the sole purpose of verification of Medicaid eligibility where the recipient has requested Medicaid payment for medical services has been requested by authorized parties or where otherwise permitted by federal or state statute or regulationservices; (b) verification of eligibility under the system is not a guarantee of payment and the records as to the recipient’s eligibility status shall be the final authority; (c) Provider indemnifies and holds harmless each State, its agents and employees, from any and all claims by such Provider or any recipient who is aggrieved by the actions of Provider any party hereunder; and (d) Customer is an approved Medicaid provider in each State to which it submits eligibility Transactions, and has supplied its correct Provider Identification Number for each such State on the signatory page hereto; and (e) Provider agrees to abide by the Federal and State regulations regarding confidentiality of information. 5.4 5.3 Provider hereby appoints CHC ENVOY as its attorney-in-fact for the limited purpose of using the information Provider provides to submit electronic Transactions and/or sign hard copy (paper) Transactions on Provider’s behalf to third- third-party Payers payers or processors, including but not limited to commercial insurers, Medicare, Medicaid, and government agencies, and, where appropriate, agencies or carriers covering work-related accident or illness benefits where Provider’s signature is required for Transaction processing. Provider acknowledges that CHC ENVOY is not responsible for the content or adjudication of any Medicare, Medicaid, work-related accident or illness claim or other insurance claim, claim and Provider retains all liability on such claims and agrees to indemnify and hold CHC ENVOY harmless on account of all such claims, including the reconciliation or adjustment of any claim. 5.5 5.4 Provider shall guarantee that all Transactions submitted to the CHC ENVOY Services by Provider will be on behalf of physicians or suppliers that have executed appropriate written authorizations authorization for such submission, submission and a true copy of such authorization shall be furnished to CHC ENVOY upon request. Provider also shall guarantee that each claim shall be maintained by Provider for a period of seventy-two (72) months in such manner as to assure that such claim can be associated or identified with a claim form (“Source Document”) from the applicable physician or suppliersupplier and said Source Document shall be maintained by Provider for a period of 72 months. 5.6 5.5 Provider shall retain records relative to Provider’s use of the CHC ENVOY Services in accordance with sound business practices, practices and CHC ENVOY may request access during normal business hours upon reasonable advance prior notice to such records as are reasonably necessary to examine Provider’s compliance with its obligations hereunder. Provider shall use these services for dental purposes onlyand the ENVOY Services provided pursuant to this Agreement during normal business hours upon reasonable advance prior notice.