Common use of Disclosure of Records Clause in Contracts

Disclosure of Records. (a) Group and each Group Provider shall comply with all provisions of the Omnibus Reconciliation Act of 1980 regarding access to books, documents, and records. Without limiting the foregoing, Group shall maintain such records and provide such information to Blue Shield as well as to DMHC, CMS, any Peer Review Organization (“PRO”) with which Blue Shield contracts as required by CMS, the U.S. Comptroller General, their designees and any other governmental officials entitled to such access by law (collectively, “Governmental Officials”) as required by law and as may be necessary for compliance by Blue Shield with the provisions of all state and federal laws governing Blue Shield. Blue Shield and Government Officials shall have access to, and copies of, at reasonable time upon request, the medical records, books, charts, and papers relating to the Provider’s provision of health care services to Members, the cost of such services, and payment received by the Provider from the Member (or from others on their behalf), and to the financial condition of the provider. Such records described herein shall be maintained at least six (6) years from the end of each Agreement Year, and, if this Agreement is applicable to Blue Shield 65 Plus, six (6) years from the close of CMS’ fiscal year in which the contract was in effect (or for a particular record or group of records, a longer time period when or DMHC requests such longer record retention and Group is notified of such request by Blue Shield), and in no event for a shorter period than as may be required by the Xxxx-Xxxxx Act and the regulations promulgated thereunder. All records of Group/Providers shall be maintained in accordance with the general standards applicable to such book or record keeping and shall be maintained during any governmental audit or investigation. (b) Group shall, on request, disclose to Government Officials the method and amount of compensation or other consideration to be received by it from Blue Shield or payable by Group to its subcontractors. Group shall maintain and make available to Government Officials: (i) its subcontracts, and (ii) compensation/financial records relating to such subcontracts and compensation from Blue Shield. (c) Upon forty-eight (48) hours notice, Group shall make any records of its quality improvement and utilization review activities pertaining to Members and provider credentialing files available to Blue Shield’s quality and utilization review committee. Such sharing of records between the two committees shall be in accordance with, and limited to, Sections 1157 of the California Evidence Code and 1370 of the California Health and Safety Code and shall not be construed as a waiver of any rights or privileges conferred on either party by those statutes. (d) Blue Shield, at its sole cost and expense, and with reasonable prior notice to Group, may from time to time audit the books and records of Group as they relate to its services, claims payments, authorization turn-around times, reporting, and xxxxxxxx under this Agreement.

Disclosure of Records. (a) Group and each Group Provider shall comply with all provisions of the Omnibus Reconciliation Act of 1980 regarding access to books, documents, and records. Without limiting the foregoing, Group shall maintain such records and provide such information to Blue Shield as well as to DMHC, CMS, any Peer Review Organization (“PRO”) with which Blue Shield contracts as required by CMSbyCMS, the U.S. Comptroller General, their designees and any other governmental officials entitled to such access by law (collectively, “Governmental Officials”) as required by law and as may be necessary for compliance by Blue Shield with the provisions of all state and federal laws governing Blue Shield. Blue Shield and Government Officials shall have access to, and copies of, at reasonable time upon request, the medical records, books, charts, and papers relating to the Provider’s provision of health care services to Members, the cost of such services, and payment received by the Provider from the Member (or from others on their behalf), and to the financial condition of the provider. Such records described herein shall be maintained at least six (6) years from the end of each Agreement Year, and, if this Agreement is applicable to Blue Shield 65 Plus, six (6) years from the close of CMS’ fiscal year in which the contract was in effect (or for a particular record or group of records, a longer time period when or DMHC requests such longer record retention and Group is notified of such request by Blue Shield), and in no event for a shorter period than as may be required by the Xxxx-Xxxxx Act and the regulations promulgated thereunder. All records of Group/Providers shall be maintained in accordance with the general standards applicable to such book or record keeping and shall be maintained during any governmental audit or investigation. (b) Group shall, on request, disclose to Government Officials the method and amount of compensation or other consideration to be received by it from Blue Shield or payable by Group to its subcontractors. Group shall maintain and make available to Government Officials: (i) its subcontracts, and (ii) compensation/financial records relating to such subcontracts and compensation from Blue Shield. (c) Upon forty-eight (48) hours notice, Group shall make any records of its quality improvement and utilization review activities pertaining to Members and provider credentialing files available to Blue Shield’s quality and utilization review committee. Such sharing of records between the two committees shall be in accordance with, and limited to, Sections 1157 of the California Evidence Code and 1370 of the California Health and Safety Code and shall not be construed as a waiver of any rights or privileges conferred on either party by those statutes. (d) Blue Shield, at its sole cost and expense, and with reasonable prior notice to Group, may from time to time audit the books and records of Group as they relate to its services, claims payments, authorization turn-around times, reporting, and xxxxxxxx under this Agreement.

Disclosure of Records. (a) Group and each Group Provider shall comply with all provisions of the Omnibus Reconciliation Act of 1980 regarding access to books, documents, and records. Without limiting the foregoing, Group shall maintain such records and provide such information to Blue Shield as well as to DMHC, CMS, any Peer Review Organization (“PRO”) with which Blue Shield contracts as required by CMS, the U.S. Comptroller General, their designees and any other governmental officials entitled to such access by law (collectively, “Governmental Officials”) as required by law and as may be necessary for compliance by Blue Shield with the provisions of all state and federal laws governing Blue Shield. Blue Shield and Government Officials shall have access to, and copies of, at reasonable time upon request, the medical records, books, charts, and papers relating to the Provider’s provision of health care services to Members, the cost of such services, and payment received by the Provider from the Member (or from others on their behalf), and to the financial condition of the provider. Such records described herein shall be maintained at least six (6) years from the end of each Agreement Year, and, if this Agreement is applicable to Blue Shield 65 PlusPlus , six (6) years from the close of CMS’ fiscal year in which the contract was in effect (or for a particular record or group of records, a longer time period when or DMHC requests such longer record retention and Group is notified of such request by Blue Shield), and in no event for a shorter period than as may be required by the XxxxKxxx-Xxxxx Act and the regulations promulgated thereunder. All records of Group/Providers shall be maintained in accordance with the general standards applicable to such book or record keeping and shall be maintained during any governmental audit or investigation. (b) Group shall, on request, disclose to Government Officials the method and amount of compensation or other consideration to be received by it from Blue Shield or payable by Group to its subcontractors. Group shall maintain and make available to Government Officials: (i) its subcontracts, and (ii) compensation/financial records relating to such subcontracts and compensation from Blue Shield. (c) Upon forty-eight (48) hours notice, Group shall make any records of its quality improvement and utilization review activities pertaining to Members and provider credentialing files available to Blue Shield’s quality and utilization review committee. Such sharing of records between the two committees shall be in accordance with, and limited to, Sections 1157 of the California Evidence Code and 1370 of the California Health and Safety Code and shall not be construed as a waiver of any rights or privileges conferred on either party by those statutes. (d) Blue Shield, at its sole cost and expense, and with reasonable prior notice to Group, may from time to time audit the books and records of Group as they relate to its services, claims payments, authorization turn-around times, reporting, and xxxxxxxx bxxxxxxx under this Agreement.