PROVIDER MANUAL
88
36.
PROVIDER REGISTRATION
88
37.
SUBCONTRACTS
88
38.
CLAIMS PAYMENT/HEALTH INFORMATION SYSTEM
90
39.
SPECIALTY CONTRACTS
94
40.
HOSPITAL SUBCONTRACTING AND REIMBURSEMENT
95
41.
RESPONSIBILITY FOR NURSING FACILITY REIMBURSEMENT
95
42.
INCENTIVES/PAY FOR PERFORMANCE
96
43.
MANAGEMENT SERVICES AGREEMENT AND COST ALLOCATION PLAN
96
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Acute Care Contract
10/01/2016
Contract No. YH14-0001
44.
MATERIAL CHANGE TO BUSINESS OPERATIONS
97
45.
MINIMUM CAPITALIZATION
97
46.
PERFORMANCE BOND OR BOND SUBSTITUTE
97
47.
AMOUNT OF PERFORMANCE BOND
98
48.
ACCUMULATED FUND DEFICIT
98
49.
ADVANCES, DISTRIBUTIONS, LOANS AND INVESTMENTS
98
50.
FINANCIAL VIABILITY STANDARDS
98
51.
SEPARATE INCORPORATION
100
52.
MERGER, ACQUISITION, REORGANIZATION, JOINT VENTURE AND CHANGE IN OWNERSHIP
100
53.
COMPENSATION
100
54.
PAYMENTS TO CONTRACTORS
103
55.
CAPITATION ADJUSTMENTS
104
56.
MEMBER BILLING AND LIABILITY FOR PAYMENT
105
57.
REINSURANCE
105
58.
COORDINATION OF BENEFITS AND THIRD PARTY LIABILITY
109
59.
COPAYMENTS
112
60.
MEDICARE SERVICES AND COST SHARING
112
61.
MARKETING
113
62.
CORPORATE COMPLIANCE
113
63.
RECORDS RETENTION
117
64.
SYSTEMS AND DATA EXCHANGE REQUIREMENTS
118
65.
ENCOUNTER DATA REPORTING
120
66.
ENROLLMENT AND CAPITATION TRANSACTION UPDATES
122
67.
PERIODIC REPORTING REQUIREMENTS
123
68.
REQUESTS FOR INFORMATION
123
69.
DISSEMINATION OF INFORMATION
123
70.
OPERATIONAL AND FINANCIAL READINESS REVIEWS
124
71.
MONITORING AND OPERATIONAL REVIEWS
124
72.
SANCTIONS
125
73.
BUSINESS CONTINUITY AND RECOVERY PLAN
126
74.
MEDICARE REQUIREMENTS
127
75.
PENDING ISSUES
128
76.
VALUE-BASED PURCHASING
129
SECTION E: CONTRACT TERMS AND CONDITIONS
132
1.
ADVERTISING AND PROMOTION OF CONTRACT
132
2.
APPLICABLE LAW
132
3.
ARBITRATION
132
4.
ASSIGNMENT AND DELEGATION
132
5.
ASSIGNMENT OF CONTRACT AND BANKRUPTCY
132
6.
AUDITS AND INSPECTIONS
132
7.
AUTHORITY
132
8.
CHANGES
132
9.
CHOICE OF FORUM
133
10.
COMPLIANCE WITH APPLICABLE LAWS, RULES AND REGULATIONS
133
11.
CONFIDENTIALITY AND DISCLOSURE OF CONFIDENTIAL INFORMATION
133
12.
CONFLICT OF INTEREST
133
13.
CONTINUATION OF PERFORMANCE THROUGH TERMINATION
134
14.
CONTRACT
134
15.
CONTRACT INTERPRETATION AND AMENDMENT
134
16.
COOPERATION WITH OTHER CONTRACTORS
134
17.
COVENANT AGAINST CONTINGENT FEES
134
18.
DATA CERTIFICATION
134
19.
DISPUTES
135
20.
E-VERIFY REQUIREMENTS
135
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Acute Care Contract
10/01/2016
Contract No. YH14-0001
21.
EFFECTIVE DATE
135
22.
EMPLOYEES OF THE CONTRACTOR
135
23.
FEDERAL IMMIGRATION AND NATIONALITY ACT
135
24.
GRATUITIES
135
25.
INCORPORATION BY REFERENCE
135
26.
INDEMNIFICATION
135
27.
INDEMNIFICATION - PATENT AND COPYRIGHT
136
28.
INSURANCE
136
ATTACHMENT E-1
137
29.
IRS W9 FORM
141
30.
LIMITATIONS ON BILLING AND COLLECTION PRACTICES
141
31.
LOBBYING
141
32.
NO GUARANTEED QUANTITIES
141
33.
NON-DISCRIMINATION
141
34.
NON-EXCLUSIVE REMEDIES
141
35.
OFF-SHORE PERFORMANCE OF WORK PROHIBITED
141
36.
ORDER OF PRECEDENCE
141
37.
OWNERSHIP OF INFORMATION AND DATA
142
38.
RESERVED
142
39.
RELATIONSHIP OF PARTIES
142
40.
RIGHT OF OFFSET
142
41.
RIGHT TO ASSURANCE
142
41.
RESERVED
142
42.
SEVERABILITY
143
43.
SUSPENSION OR DEBARMENT
143
44.
TEMPORARY MANAGEMENT/OPERATION OF A CONTRACTOR
143
45.
TERM OF CONTRACT AND OPTION TO RENEW
144
46.
TERMINATION
144
47.
TERMINATION - AVAILABILITY OF FUNDS
145
48.
TERMINATION FOR CONFLICT