Common use of HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS Clause in Contracts

HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 5.1 Payments to Provider. Subcontractor or Health Plan (as applicable) shall pay Provider on a timely basis as set forth in the Agreement, the applicable State Contract and applicable State and federal law and regulations, including but not limited to 42 U.S.C. 1396u-2(f) and 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. Unless a different timeframe is set forth in the Agreement, Subcontractor or Health Plan (as applicable) will pay 90% of claims from physicians in an individual or group practice which can be processed without obtaining additional information from the physician or from a third party within ninety (90) days of the date of receipt of the claim. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the applicable State Contract. Unless Subcontractor or Health Plan (as applicable) otherwise requests assistance from Provider, Subcontractor or Health Plan will be responsible for third party collections in accordance with the terms of the applicable State Contract.