Common use of Delegate’s Obligations Clause in Contracts

Delegate’s Obligations. Delegate agrees that it shall: 1.1 Acknowledge and agree that Delegate’s policies and procedures are subject to Delegator’s review and written approval prior to any delegation of credentialing functions. 1.2 Accept responsibility and the obligation for all delegated credentialing and recredentialing functions and activities in TABLE 1, which is included hereto and is incorporated by reference herein as it relates to Delegate’s organizational providers who are or will be rendering services to Members. All delegated credentialing and recredentialing functions and activities shall be carried out in accordance with the obligations in the Addendum and this Credentialing Attachment. 1.3 Agree to cooperate and comply with the standards and requirements provided by Delegator, which will be updated from time to time, including without limitation, the credentialing criteria and credentialing policies. Delegate further represents and acknowledges that Delegate's credentialing and recredentialing program, policies and processes must meet or exceed the standards and criteria requirements set forth by Delegator. 1.4 Maintain a credentialing committee, a credentialing and recredentialing program, and all related policies procedures and processes in compliance with state and federal law and Accreditation Organization requirements as they may be amended from time to time. 1.5 Delegate shall cooperate with Delegator’s efforts to implement quality improvement and other activities related to the credentialing and recredentialing program. 1.6 Acknowledge that Delegator, or its designee, retains the right to approve or deny new or renewing organizational providers and sites and to terminate or suspend organizational providers and sites from participation in any of Delegator’s networks. Delegator retains the ultimate responsibility for the credentialing and recredentialing of all providers in any of Delegator’s networks. 1.7 Acknowledge and agree that all organizational providers must be fully credentialed / recredentialed by the Delegate prior to rendering any services to Members. 1.8 Obtain, evaluate, verify and provide to Delegator or its designee, upon request, any and all information necessary and appropriate for the credentialing of applicants and recredentialing of participating organizational providers. All verifications shall be thoroughly documented according to state and federal law and Accreditation Organization requirements. 1.9 Provide a complete report of all participating organizational providers credentialed and/or recredentialed by Delegate on a semi-annual basis to Delegator. All reports are to be sent via secured email to your assigned delegation compliance consultant. Delegate shall include the elements indicated below in all credentialing reports: • Organizational Provider Name • Organizational Provider Type • NPI Number • Initial Credentialing Date • Last Recredentialing Date • State of Organizational Provider Location 1.10 In addition, Delegate shall submit reports containing all credentialing approvals and denials to Delegator’s appropriate network operations department within thirty (30) calendar days of the credentialing decision date. 1.11 Acknowledge that Delegator retains all other credentialing functions not specified as the

Delegate’s Obligations. Delegate agrees that it shallwill: 1.1 Acknowledge and agree that Delegate’s credentialing policies and procedures procedures, are subject to Delegator’s review and written approval prior to any delegation of credentialing functions. 1.2 Accept responsibility and the obligation for all delegated credentialing and recredentialing functions and activities in TABLE 1, which is included hereto and is incorporated by reference herein reference, as it relates they relate to Delegate’s organizational providers employed and / or contracted practitioners who are or will be rendering services to Members. All delegated credentialing and recredentialing functions and activities shall be carried out in accordance with the obligations in the Addendum and this Credentialing Attachment. 1.3 Agree to cooperate Cooperate and comply with the standards and requirements provided by Delegator, which will be updated from time to time, including without limitationincluding, but not limited to, the credentialing criteria and credentialing policies. Delegate further represents and acknowledges that Delegate's credentialing and recredentialing program, policies and processes must meet or exceed the standards and criteria requirements set forth by Delegator. 1.4 Maintain a credentialing committee, a credentialing and recredentialing program, and all related policies procedures and processes in compliance with state and federal law and Accreditation Organization requirements as they may be amended from time to time. 1.5 Delegate shall cooperate with Delegator’s efforts to implement quality improvement and other activities related to the credentialing and recredentialing program. 1.6 Acknowledge that Delegator, or its designee, retains the right to approve or deny new or renewing organizational providers and sites practitioner and to terminate or suspend organizational providers and sites individual practitioners from participation in any of Delegator’s networks. Delegator retains the ultimate responsibility for the credentialing and recredentialing of all providers in any of Delegator’s networks. 1.7 Acknowledge and agree that all organizational providers practitioners must be fully credentialed / credentialed/recredentialed by the Delegate prior to rendering any services to Members.the 1.8 Obtain, evaluate, verify and provide to Delegator or its designee, upon request, any and all information necessary and appropriate for the credentialing of applicants and recredentialing of participating organizational providersParticipating Providers. All verifications shall be thoroughly documented according to state and federal law and Accreditation Organization requirements. 1.9 Provide a complete report of all participating organizational providers Participating Providers credentialed and/or recredentialed by Delegate on a semi-annual basis to Delegator. All reports are to be sent via secured email to your assigned delegation compliance consultant. Delegate shall include the elements indicated below in all credentialing reports: • Organizational Provider Name Practitioner • Organizational Provider Type Degree • Practicing Specialty • NPI Number • Initial Credentialing Date • Last Recredentialing Date • Specialist/Hospitalist Indicator • State of Organizational Provider LocationPractice • Active Hospital Privileges (if applicable) 1.10 In addition, Delegate shall submit reports containing all credentialing approvals and denials to Delegator’s appropriate network operations department within thirty (30) calendar days of the credentialing decision date. 1.11 Acknowledge that Delegator retains all other credentialing functions not specified as thethe Delegate’s responsibility in this Attachment.

Delegate’s Obligations. Delegate agrees that it shallwill: 1.1 Acknowledge and agree that Delegate’s policies and procedures are subject to Delegator’s review and written approval prior to any delegation of credentialing claims processing functions. 1.2 Accept responsibility and the obligation for all claims processing functions delegated credentialing and recredentialing functions and activities in TABLE 1, which is included hereto and is incorporated by reference herein as it relates to Delegate’s organizational providers who are or will be rendering hereunder for those services rendered to Members. All delegated credentialing . 1.3 Be solely responsible for acquiring, operating, and recredentialing functions maintaining any equipment or software necessary in performing its duties hereunder. 1.4 Conduct claims adjudication and activities shall be carried out processing in accordance with Delegator’s policies, procedures, and program requirements, Member’s Plan, state and federal laws, rules, and regulations, and the obligations in the Addendum and this Credentialing Attachment. 1.3 Agree requirements of all regulatory bodies or Accreditation Organizations to cooperate and comply with the standards and requirements provided by Delegator, which will be updated from time to timeDelegator is subject, including without limitationbut not limited to all privacy and electronic data security laws or regulations, the credentialing criteria and credentialing policies. Delegate further represents and acknowledges that Delegate's credentialing and recredentialing program, policies and processes must meet or exceed the standards and criteria requirements set forth and/or as required by Delegator. 1.4 Maintain a credentialing committee1.5 Represent and warrant that Delegate’s claims processing processes are compliant with the most current American Medical Association (AMA) Current Procedural Terminology (CPT®) code sets, a credentialing Healthcare Common Procedure Coding System (HCPCS) code sets, International Classification of Diseases, 10th Edition/Revision (ICD-10) code sets (and recredentialing programfuture ICD revisions when effective), Centers for Medicare & Medicaid Services (CMS) guidelines and national coverage determinations (NCDs), and all related policies procedures and processes in compliance with state and federal law and Accreditation Organization requirements as they may be amended from time to time. 1.5 Delegate shall cooperate with Delegator’s efforts to implement quality improvement and other activities related to the credentialing and recredentialing programCMS National Correct Coding Initiative (NCCI). 1.6 Acknowledge and agree that Delegator, or its designee, Delegator retains the right and final authority to approve pay any claims for its Members regardless of the delegation of any such functions or deny new or renewing organizational providers and sites and activities to terminate or suspend organizational providers and sites from participation in any of Delegator’s networks. Delegator retains the ultimate responsibility for the credentialing and recredentialing of all providers in any of Delegator’s networksDelegate. 1.7 Acknowledge and agree that all organizational providers must any amounts authorized by Delegate for payment by Delegator may be fully credentialed / recredentialed by the Delegate prior to rendering any services to Memberscharged against Delegate’s funding. 1.8 ObtainIf required by state and/or federal law, evaluaterule or regulation, verify Delegate, at all times during the term of this Addendum, shall obtain, and maintain in good standing a Third Party Administrator (TPA) license/certificate or other state required license/registration/certification. Delegate shall provide Delegator a copy of the appropriate license/registration/certification number(s) prior to Delegator or its designee, execution of this Addendum and upon request, any and all information necessary and appropriate for the credentialing of applicants and recredentialing of participating organizational providers. All verifications shall be thoroughly documented according to state and federal law and Accreditation Organization requirementsrenewal thereafter. 1.9 Provide a complete report financial guarantee, acceptable to Delegator prior to implementation of all participating organizational providers credentialed and/or recredentialed by Delegate on any delegation of claims processing, including, but not limited to, a semi-annual basis letter of credit, to Delegator. All reports are ensure its continued financial solvency and Delegate’s ability to be sent via secured email to your assigned delegation compliance consultant. Delegate shall include the elements indicated below in all credentialing reports: • Organizational Provider Name • Organizational Provider Type • NPI Number • Initial Credentialing Date • Last Recredentialing Date • State of Organizational Provider Locationadjudicate and process claims hereunder. 1.10 In addition, Delegate shall submit reports containing all credentialing approvals and denials to Delegator, financial information, upon request, as proof of their continued financial solvency. Financial information submitted should include the following: a. Recent audited financial statements (balance sheet, statement of operations, statement of cash flows and notes to the financial statements). If the audited financial statements are over six (6) months old, provide current internal financials with projections (e.g. 6 month- ended financials or quarterly reports). b. If Delegate has not been audited, Delegate is to provide recent internally prepared financial statements (balance sheet, statement of operations and cash flow statement). c. Delegate’s appropriate network operations department within thirty (30) calendar days of chief financial officer and/or owner will certify/attest to their correctness by adding his/her signature to the credentialing decision datefinancial statements provided to Delegator. 1.11 Delegate agrees to permit any regulatory agency to examine, at any time, information the agency deems relevant to determine the financial solvency of the Delegate or to review the Delegate’s ability to meet its responsibilities in connection with any function delegated to Delegate by Delegator. 1.12 Delegate will submit claim/Encounter data in the format defined in the Process Integration Attachment (eConnectivity). 1.13 Acknowledge that Delegator retains all other credentialing claim processing functions not specified as the