Plan Access to and Requests for Provider Records. Provider and its designees shall comply with all applicable state and federal record keeping and retention requirements, and, as set forth in the provider manual(s) and/or Participation Attachment(s), shall permit Plan or its designees to have, with appropriate working space and without charge, on-site access to and the right to perform an Audit, examine, copy, excerpt and transcribe any books, documents, papers, and records related to Member's medical and billing information within the possession of Provider and inspect Provider's operations, which involve transactions relating to Members and as may be reasonably required by Plan in carrying out its responsibilities and programs including, but not limited to, assessing quality of care, complying with quality initiatives/measures, Medical Necessity, concurrent review, appropriateness of care, accuracy of Claims coding and payment, risk adjustment assessment as described in the provider manual(s), including but not limited to completion of the Encounter Facilitation Form (also called the "SOAP" note), compliance with this Agreement, and for research. In lieu of on-site access, at Plan's request, Provider or its designees shall submit records to Plan, or its designees via photocopy or electronic transmittal, within thirty (30) days, at no charge to Plan from either Provider or its designee. Provider shall make such records available to the state and federal authorities involved in assessing quality of care or investigating Member grievances or complaints in compliance with Regulatory Requirements. Provider acknowledges that failure to submit records to Plan in accordance with this provision and/or the provider manual(s), and/or Participation Attachment(s) may result in a denial of a Claim under review, whether on pre-payment or post-payment review, or a payment retraction on a paid Claim, and Provider is prohibited from balance billing the Member in any of the foregoing circumstances.
Plan Access to and Requests for Provider Records. Provider agrees that Anthem or its authorized representative may review, audit, and duplicate data and other records maintained on Covered Individuals, including but not limited, to medical records or other records relating to billing, payment and assignment, to the extent permitted by state and federal law. Anthem or its authorized representatives shall have access at reasonable times upon demand to the books, records and papers of Provider relating to the services Provider provides to Covered Individuals, to the cost thereof, and to payments Provider receives from Covered Individuals or others on their behalf. Provider shall maintain such records and provide such information to Anthem or its authorized representatives and the Director of the California Department of Managed Health Care (DMHC) as may be necessary for Anthem’s compliance with the requirements of the Xxxx-Xxxxx Act. Provider shall maintain such records for at least six (6) years, and such obligations shall not be terminated upon a termination of this Agreement, whether by rescission or otherwise. Anthem agrees to reimburse Provider quarterly for reasonable expenses related to an audit not to exceed the lesser of ten (10) cents per page or a total of twenty-five dollars ($25.00) related to the duplication and preparation of requested records. Provider shall maintain such records and make such records available to applicable state and federal regulatory agencies, including the Director of the California Department of Managed Health Care, CMS and the Department of Health Services, as may be necessary for compliance by Anthem with the rules and regulations of said agencies. Anthem maintains the right to audit such records to determine the appropriateness of payments made. Anthem’s audit policy is described in the provider manual(s). Provider agrees to provide Anthem and/or the DMHC with requested information necessary for Anthem’s compliance with applicable regulatory and statutory requirements. Provider does not waive its rights pursuant to California Evidence Code Section 1156 through 1157.7 or successor provisions. These confidentiality provisions shall remain in effect notwithstanding any subsequent termination of this Agreement.
Plan Access to and Requests for Provider Records. In addition to the terms and conditions of the Plan Access to and Requests for Provider Records section of the Agreement, Anthem and its designees shall have access at reasonable times upon demand to the books, records, and papers of Provider relating to the services Provider provides to Members, to the cost thereof, and to payments Provider receives from Members or others on their behalf, including billing and assignment. Anthem and/or its designate may review, audit, and duplicate such records. Provider shall maintain such records and provide such information to Anthem and the Director of the California Department of Managed Health Care as may be necessary for Anthem compliance with the Certain confidential information contained in this document, marked by [**], has been omitted because American Well Corporation has determined that the information (i) is not material and (ii) is the type that American Well Corporation customarily and actually treats as private or confidential. requirements of the Kxxx-Xxxxx Act. Provider shall maintain such records for at least six (6) years, and such obligations shall not be terminated upon a termination of this Agreement, whether by rescission or otherwise.
