Common use of Provision of Covered Services Clause in Contracts

Provision of Covered Services. Contractor shall cause each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.1); • Credentialing, including, maintenance of licensure and insurance (Section 3.16); • Customer service standards (Section 3.18); • Utilization review and appeal processes (Section 3.17); • Maintenance of a corporate compliance program (Section 3.19); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) • Appeals and grievances (Section 3.26); • Enrollee and marketing materials (Section 3.27); • Disclosure of information required by the Exchange, including, financial and clinical (Section 3.31; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.32); • Conflict of interest and integrity (Section 3.33); • Other laws (Section 3.35); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); • Security and privacy requirements, including, compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e)); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.15); • Credentialing, including, maintenance of licensure and insurance (Section 3.16); • Customer service standards (Section 3.18); • Utilization review and appeal processes (Section 3.17); • Maintenance of a corporate compliance program (Section 3.19); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) 3.26); • Appeals and grievances (Section 3.263.27); • Enrollee and marketing materials (Section 3.273.28); • Disclosure of information required by the Exchange, including, financial and clinical (Section 3.313.32; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.323.33); • Conflict of interest and integrity (Section 3.333.34); • Other laws (Section 3.35); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) ); • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); • Security and privacy requirements, including, including compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractorincluding, and which may include without limitation, those relating to the following: • Furtherance of objectives and mission of the Exchange (Section 1.01) • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.1); • Credentialing, including, maintenance of licensure and insurance (Section 3.16); • Customer service standards (Section 3.18); • Utilization review and appeal processes (Section 3.17); • Maintenance of a corporate compliance program (Section 3.19); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) • Appeals and grievances (Section 3.26); • Enrollee and marketing materials (Section 3.27); • Disclosure of information required by the Exchange, including, financial and clinical (Section 3.31; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.32); • Conflict of interest and integrity (Section 3.33); • Other laws (Section 3.35); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); • Security and privacy requirements, including, compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: •  Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c3.05(b)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d3.05(c) and (ed)); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.13); •  Credentialing, including, maintenance of licensure and insurance (Section 3.163.14); •  Customer service standards (Section 3.183.16); •  Utilization review and appeal processes (Section 3.173.15); •  Maintenance of a corporate compliance program (Section 3.193.17); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 3.18 to 3.25) • 3.24);  Appeals and grievances (Section 3.263.25); •  Enrollee and marketing materials (Section 3.273.26); •  Disclosure of information required by the Exchange, includingincluding if applicable, financial and clinical (Section 3.313.30; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.323.31); •  Conflict of interest and integrity (Section 3.333.32); •  Other laws (Section 3.353.33); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards;; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) • );  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees Enrollees, if applicable (Article 7); •  Security and privacy requirements, including, including compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure asensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e)); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.15); • Credentialing, including, maintenance of licensure and insurance (Section 3.16); • Customer service standards (Section 3.18); • Utilization review and appeal processes (Section 3.17); • Maintenance of a corporate compliance program (Section 3.19); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) 3.26); • Appeals and grievances (Section 3.263.27); • Enrollee and marketing materials (Section 3.273.28); • Disclosure of information required by the Exchange, includingincluding if applicable, financial and clinical (Section 3.313.32; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.323.33); • Conflict of interest and integrity (Section 3.333.34); • Other laws (Section 3.35); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) ); • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees Enrollees, if applicable (Article 7); • Security and privacy requirements, including, including compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: •  Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c3.05(b)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d3.05(c) and (ed)); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.13); •  Credentialing, including, maintenance of licensure and insurance (Section 3.163.14); •  Customer service standards (Section 3.183.16); •  Utilization review and appeal processes (Section 3.173.15); •  Maintenance of a corporate compliance program (Section 3.193.17); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 3.18 to 3.25) • 3.24);  Appeals and grievances (Section 3.263.25); •  Enrollee and marketing materials (Section 3.273.26); •  Disclosure of information required by the Exchange, includingincluding if applicable, financial and clinical (Section 3.313.30; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.323.31); •  Conflict of interest and integrity (Section 3.333.32); •  Other laws (Section 3.353.33); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) • );  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees Enrollees, if applicable (Article 7); •  Security and privacy requirements, including, including compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include may, includeing the following, without limitation, those relating to the following: • Furtherance of objectives and mission of the Exchange (Section 1.01)  Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.1); •  Credentialing, including, maintenance of licensure and insurance (Section 3.16); •  Customer service standards (Section 3.18); •  Utilization review and appeal processes (Section 3.17); •  Maintenance of a corporate compliance program (Section 3.19); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) •  Appeals and grievances (Section 3.26); •  Enrollee and marketing materials (Section 3.27); •  Disclosure of information required by the Exchange, including, financial and clinical (Section 3.31; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.32); •  Conflict of interest and integrity (Section 3.33); •  Other laws (Section 3.35); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) •  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); •  Security and privacy requirements, including, compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: •  Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.1); •  Credentialing, including, maintenance of licensure and insurance (Section 3.16); •  Customer service standards (Section 3.18); •  Utilization review and appeal processes (Section 3.17); •  Maintenance of a corporate compliance program (Section 3.19); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) •  Appeals and grievances (Section 3.26); •  Enrollee and marketing materials (Section 3.27); •  Disclosure of information required by the Exchange, including, financial and clinical (Section 3.31; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.32); •  Conflict of interest and integrity (Section 3.33); •  Other laws (Section 3.35); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) •  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); •  Security and privacy requirements, including, compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.061.7); • Relationship of the parties as independent contractors (Section 1.08(a1.3(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b1.3(b)); • Participating Provider directory requirements (Section 3.05(c)3.4.4); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e3.3.2); • NoticeNotices, network requirements and other obligations relating to costs of out-of-network services and other benefits (Section 3.13.4.3); • CredentialingProvider credentialing, including, ,including maintenance of licensure and insurance (Section 3.163.4.2); • Customer service standards (Section 3.183.6); • Utilization review and appeal processes (Section 3.174.3); • Maintenance of a corporate compliance program (Section 3.191.2); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) • Article 2); Appeals and grievances (Section 3.263.6.2); • Enrollee and marketing materials (Section 3.272.6); • Disclosure of information required by the Exchange, includingincluding if applicable, financial and clinical (Section 3.311.13; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.321.11); • Conflict of interest and integrity (Section 3.331.12); • Other laws (Section 3.351.14); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) • ); Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees Enrollees, if applicable (Article 7); • Security and privacy requirements, including, including compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10). In addition to the foregoing, Contractor shall include in each Provider Agreement a requirement that Participating Providers comply with other applicable laws, rules and regulations. The descriptions set forth shall not be deemed to limit the obligations set forth in the Agreement, as amended from time to time.

Provision of Covered Services. Contractor shall cause undertake commercially reasonable efforts to require each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c3. 07(b)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d3. (c) and (ed)); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.17); •  Credentialing, including, maintenance of licensure and insurance (Section 3.163.18); •  Customer service standards (Section 3.183.20); •  Utilization review and appeal processes (Section 3.173.19); •  Maintenance of a corporate compliance program (Section 3.193.21); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 3.22 to 3.25) • 3.28);  Appeals and grievances (Section 3.263.29); •  Enrollee and marketing materials (Section 3.273.30); •  Disclosure of information required by the Exchange, including, financial and clinical (Section 3.313.34; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.323.35); •  Conflict of interest and integrity (Section 3.333.36); •  Other laws (Section 3.353.37); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) • );  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); •  Security and privacy requirements, including, including compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause undertake commercially reasonable efforts to require each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e)); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.15); •  Credentialing, including, maintenance of licensure and insurance (Section 3.16); •  Customer service standards (Section 3.18); •  Utilization review and appeal processes (Section 3.17); •  Maintenance of a corporate compliance program (Section 3.19); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) • 3.26);  Appeals and grievances (Section 3.263.27); •  Enrollee and marketing materials (Section 3.273.28); •  Disclosure of information required by the Exchange, including, financial and clinical (Section 3.313.32; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.323.33); •  Conflict of interest and integrity (Section 3.333.34); •  Other laws (Section 3.35); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) • );  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); •  Security and privacy requirements, including, including compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, compliesy with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e)); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.15); • Credentialing, including, maintenance of licensure and insurance (Section 3.16); • Customer service standards (Section 3.18); • Utilization review and appeal processes (Section 3.17); • Maintenance of a corporate compliance program (Section 3.19); • Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) 3.26); • Appeals and grievances (Section 3.263.27); • Enrollee and marketing materials (Section 3.273.28); • Disclosure of information required by the Exchange, including, financial and clinical (Section 3.313.32; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.323.33); • Conflict of interest and integrity (Section 3.333.34); • Other laws (Section 3.35); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) ); • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); • Security and privacy requirements, including, including compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: •  Coordination with the Exchange and other programs and stakeholders (Section 1.06); •  Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); •  Participating Provider directory requirements (Section 3.05(c)); •  Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d) and (e)); •  Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.15); •  Credentialing, including, maintenance of licensure and insurance (Section 3.16); •  Customer service standards (Section 3.18); •  Utilization review and appeal processes (Section 3.17); •  Maintenance of a corporate compliance program (Section 3.19); •  Enrollment and eligibility determinations and collection practices (Sections 3.20 to 3.25) • 3.26);  Appeals and grievances (Section 3.263.27); •  Enrollee and marketing materials (Section 3.273.28); •  Disclosure of information required by the Exchange, including, financial and clinical (Section 3.313.32; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); •  Nondiscrimination (Section 3.323.33); •  Conflict of interest and integrity (Section 3.333.34); •  Other laws (Section 3.35); •  Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Attachment 7, Section 7.01 of the Quality, Network Management and Delivery System Standards; •  Performance Measures, to the extent applicable to Participating Providers (Article 6) • ); Covered California – Final Health Plan Contract Attachments, May 617201, 2013 Attachment 5-1  Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees (Article 7); •  Security and privacy requirements, including, including compliance with HIPAA (Article 9); and •  Maintenance of books and records (Article 10).

Provision of Covered Services. Contractor shall cause require each Participating Provider to assure ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider shall comply with, complies with the applicable terms and conditions set forth in the Agreement, as mutually agreed upon by the Exchange and Contractor, and which may include the following: • Coordination with the Exchange and other programs and stakeholders (Section 1.06); • Relationship of the parties as independent contractors (Section 1.08(a)) and Contractor’s exclusive responsibility for obligations under the Agreement (Section 1.08(b)); • Participating Provider directory requirements (Section 3.05(c3.05(b)); • Implementation of processes to enhance stability and minimize disruption to provider network (Section 3.05(d3.05(c) and (ed)); • Notice, network requirements and other obligations relating to costs of out-of-network and other benefits (Section 3.13.13); • Credentialing, including, maintenance of licensure and insurance (Section 3.163.14); • Customer service standards (Section 3.183.16); • Utilization review and appeal processes (Section 3.173.15); • Maintenance of a corporate compliance program (Section 3.193.17); • Enrollment and eligibility determinations and collection practices (Sections 3.20 3.18 to 3.25) 3.24); • Appeals and grievances (Section 3.263.25); • Enrollee and marketing materials (Section 3.273.26); • Disclosure of information required by the Exchange, includingincluding if applicable, financial and clinical (Section 3.313.30; Quality, Network Management and Delivery System Standards (Article 4 ) and other data, books and records (Article 10)); • Nondiscrimination (Section 3.323.31); • Conflict of interest and integrity (Section 3.333.32); • Other laws (Section 3.353.33); • Quality, Network Management and Delivery System Standards to the extent applicable to Participating Providers (Article 4), including, disclosure of contracting arrangements with Participating Providers as required under Section 7.01 of the Quality, Network Management and Delivery System Standards; • Performance Measures, to the extent applicable to Participating Providers (Article 6) ); • Continuity of care, coordination and cooperation upon termination of Agreement and transition of Enrollees Enrollees, if applicable (Article 7); • Security and privacy requirements, including, including compliance with HIPAA (Article 9); and • Maintenance of books and records (Article 10).