Common use of OBLIGATIONS OF INTERWEST Clause in Contracts

OBLIGATIONS OF INTERWEST. 2.1 InterWest shall develop and operate Health Care Networks within its service area that make available Covered Services to Enrollees of Health Benefit Plans offered by Payors. Such Health Care Networks will be established through contracts with Participating Providers. 2.2 InterWest shall credential and periodically recredential all Participating Providers. Information concerning InterWest’s credentialing standards and participation requirements will be made available, upon request, to Providers. 2.3 InterWest shall market its Health Care Networks in a professional and ethical manner consistent with sound business practice. 2.4 InterWest shall negotiate and execute contracts with Payors that make Provider’s services available to Enrollees in keeping with the terms of this Agreement. In negotiating such contracts, InterWest shall make best efforts to ensure that Payors: (a) Issue ID cards to Enrollees that contain the InterWest logo (or other information that is acceptable to InterWest), the address where Participating Providers may submit claims, and the toll free number(s) which Participating Providers can call to obtain benefits, eligibility, precertification, and other information; (b) Make prompt and accurate payment to Participating Providers for Covered Services rendered to Enrollees. Claims shall be processed as promptly as possible, no later than thirty (30) days following receipt of a Clean Claim; (c) Issue Explanation of Benefits (EOBs) or payment advices that identify InterWest as the health care network used for repricing. The design of the form must be sufficient to allow Participating Providers to clearly identify amounts paid by the Health Benefit Plan, amounts owed by the Enrollee, and amounts to be written off as contractual adjustments by the Provider; and (d) Ensure that any utilization management and quality assurance programs that are in effect for Enrollees: (1) Are reasonable and do not create unnecessary administrative burdens for Participating Providers; (2) Are consistent with quality of care; (3) Are conducted locally, where practicable; and (4) Give Participating Providers right of due process for addressing compliance issues. 2.5 InterWest shall provide Participating Providers and their office staffs with education and training concerning general Health Care Network operations. 2.6 InterWest shall monitor the performance of Payors to ensure that their use of InterWest’s Health Care Networks is appropriate and that claims submitted by Participating Providers are processed and paid in accordance with the terms of this Agreement. InterWest shall work on Provider’s behalf to resolve any problems or difficulties that Provider is experiencing with a Payor. 2.7 InterWest shall procure and maintain policies of general liability and other insurance as may be necessary to insure its members, officers, and employees against claims arising in connection with this Agreement.