North Carolina Contract Requirements Sample Clauses

North Carolina Contract Requirements a. Providers shall provide physical access, reasonable accommodations - including parking, exam and waiting rooms - and accessible equipment for Members with physical or mental disabilities. b. Each Provider furnishing services to Members will maintain and share, for care coordination and as appropriate, a Member health record in accordance with professional standards and state and federal law. c. Primary Care Physicians shall perform Early and Periodic Screening, Diagnostic and Treatment for Members less than 21 years of age in accordance with the North Carolina Contract. d. Providers shall notify Health Plan when a Member is in a high level clinical setting and is being discharged, as more fully described in the Provider Manual. e. Providers shall not submit claim or encounter data for services covered under this Agreement directly to the Department. f. Provider-Preventable Condition Requirements. Providers shall comply with the requirements of 42 C.F.R. §438.3(g) including, but not limited to, the identification of provider-preventable conditions as a condition of payment, and appropriate reporting to Health Plan. g. Contracted Provider and its subcontractors shall have compliance plans that meet the requirements of 42 C.F.R. §438.608, and policies and procedures that meet the requirements of the Deficit Reduction Act of 2005. h. Contract Provider shall have policies and procedures that recognize and accept Medicaid as the payer of last resort. i. Providers shall not xxxx Members for Covered Services for any amount greater than what would be owed if the provider rendered the service directly as provided in 42 C.F.R. §§438.3(k) and 438.230(c)(1)-(2). j. Upon termination of the North Carolina Contract, Provider’s participation in Health Plan’s contracted provider networks for the North Carolina Medicaid Benefit Plans shall automatically terminate. k. Provider shall be immediately terminated by Health Plan upon a confirmed finding of fraud, waste, or abuse by the Department or the North Carolina Department of Justice Medicaid Investigations Division. l. In the event of Health Plan’s insolvency, administrative duties and records will be transferred to Comprehensive Health Management, Inc., a for-profit corporation organized under the laws of the State of Florida and experienced in the provision of administrative and management services to health maintenance organizations. m. In the case of insolvency of Health Plan, when Provider is paid on a prepaid basis ...