Your Compliance with Our Programs, Policies, and Procedures. You agree to participate in and comply with all of our Policies and Procedures, as may be enacted and revised by us from time to time with no fewer than sixty (60) days’ prior notice, unless state or federal laws or regulations require a change within a shorter time period, including, but not limited to, utilization review and management programs, credential verification programs, provider accessibility standards or policies, quality improvement and management programs, the Grievance and Appeals Process, provider sanction policies, referral policies, billing policies, claims submission policies, reimbursement policies, coordination of benefit and third party liability policies, excess payments and underpayments policies, billing and refund policies, retroactive adjustment policies, pre-admission certification policies, admission certification policies, length of stay assignment programs, concurrent review programs, prior approval programs, procedure code auditing programs, and administrative requirements. Different Policies and Procedures may apply with respect to different Benefit Plans as described in the Provider Manual. In addition, differing Policies and Procedures may be adopted and applied by an Affiliate or by another Blue Cross and/or Blue Shield plan, or through the Blue Cross and Blue Shield Association, as applicable based on the State Health Plan Member’s status. The Policies and Procedures applicable to a given Covered Service shall be those referenced in the Provider Manual in effect as of the date of service. The most recently dated Provider Manual that has been provided to you will be considered the most current, even if we have not updated the Provider Manual following the stated end date.
Appears in 5 contracts
Samples: Participation Agreement, North Carolina State Health Plan Network Participation Agreement, Participation Agreement
