Common use of Compliance and Participation Clause in Contracts

Compliance and Participation. 1. Practitioner shall be bound by and comply with the provisions of applicable state and federal laws and regulations. 2. Upon request, Practitioner shall participate in, and cooperate with OhioHealthy’s credentialing and recredentialing requirements and such other activities as OhioHealthy or its designee deems reasonably necessary in connection with its efforts to obtain and maintain NCQA, JCAHO, and/or appropriate accreditation, including without limitation, periodic site reviews of offices, records, premises and operations of Practitioner. 3. Practitioner shall comply with the requirements of, and shall participate in, such Quality Management and Utilization Management programs developed or implemented by OhioHealthy or a Payor (as agreed to by OhioHealthy), as such programs may be clarified, amended or supplemented from time to time, and the decisions, rules and regulations established under such programs, including without limitation, precertification of elective admissions and procedures, referral processes and reporting of clinical encounter data. 4. Practitioner shall comply with the requirements of, and shall participate in a Performance Improvement Plan developed or implemented by OhioHealthy or a Payor’s designee (as agreed to by OhioHealthy), following written notice to Practitioner of a failure to meet OhioHealthy’s or Payor’s standards for quality or utilization in the delivery of Covered Services as described in the applicable sections of the Ohio Revised Code. 5. Practitioner shall accept those compensation arrangements and rates set forth in this Agreement and/or the Program Attachment (or Payor or OhioHealthy supplied supplemental materials) as payment in full for those Covered Services rendered by Practitioner to Beneficiaries for those Programs in which Practitioner is a Participating Practitioner. OhioHealthy shall not be liable to Practitioner for any amounts a Payor fails to pay to Practitioner for Covered Services rendered by Practitioner. Practitioner shall hold harmless OhioHealthy against any claims for non-payment or under payment.