Common use of Provider Agreements Clause in Contracts

Provider Agreements. Contractor must have a process in place to review and authorize all Participating Provider contracts. The Participating Provider contracts must not be in conflict with any aspect of the DVHA General Provider Agreement. DVHA reserves the right to review and approve Contractor network contracts on an annual basis to ensure compliance with this Contract prior to them being sent to Participating Providers. Participating Provider contracts will contain requirements to maintain active Medicaid participation, to report any events that may impact that participation, and to immediately report any termination from Medicaid. Participating Provider agreements will also require both the Participating Providers and Contractor to comply with all applicable federal, state and local laws and regulations. Contractor shall include in all its provider agreements provisions to ensure continuation of benefits as required by law. Contractor shall identify and incorporate the applicable terms of this Contract with DVHA into its provider agreements. Under the terms of the Participating Provider contract, the provider shall agree that the applicable terms and conditions set out in the Participating Provider contract, any incorporated documents, and all applicable state and federal laws, as amended, govern the duties and responsibilities of the provider with regard to the provision of services to Members. The Participating Provider contracts shall meet the following requirements: a. Describe the provider claim dispute resolution process; b. Require each provider to maintain a current Vermont Medicaid General Provider Agreement and to be duly licensed in accordance with the appropriate state licensing board and remain in good standing with said board; c. Require providers to adhere to DVHA timely filing requirements for claims submissions; d. Include a termination clause stipulating that Contractor shall terminate its contractual relationship with the provider as soon as Contractor has knowledge that the provider’s license or Vermont Medicaid General Provider Agreement has terminated; e. Obligate the terminating provider to submit all claims or encounters for services rendered to Contractor’s Members to Fiscal Agent while serving as Contractor’s Participating Provider; f. Not obligate the provider to participate under exclusivity agreements that prohibit the provider from contracting with other state contractors; and g. Provide a copy of a Member’s medical record at no charge upon request by the Member and facilitate the transfer of the Member’s medical record to another provider at the Member’s request. For purposes of this section, Contractor agrees that its network consists of Participating Providers as defined above, which specifies that Participating Providers have a signed agreement with the Contractor meeting the requirements of this Section 5.4.