Common use of Standards For Provision of Care Clause in Contracts

Standards For Provision of Care. (a) Group and Group Providers shall maintain facilities and equipment which meet all applicable legal requirements, including accessibility, and which otherwise comply with the provider credentialing requirements developed by Blue Shield for such providers, as more fully described in the Provider Manual. Accessibility shall include compliance with the requirements of the Americans With Disabilities Act. (b) To assist Group in meeting Blue Shield requirements hereunder, Group shall, through a duly designated representative, attend occasional provider education/orientation sessions conducted by Blue Shield. (c) In providing Capitated Professional Services hereunder Group shall utilize only Group Providers who are credentialed and re-credentialed in accordance with Blue Shield’s standards as set forth in the Provider Manual, unless the Medically Necessary service is not available from a Group Provider. Group and/or each Group Provider shall provide to Blue Shield, on request, credentialing information, in such form as reasonably required by Blue Shield. (d) Group represents and warrants that during the term of this Agreement, each physician through whom it will provide Capitated Professional Services hereunder shall: (i) maintain a current, unrestricted license to practice medicine in California; and, (ii) maintain such staff privileges with at least one Blue Shield Hospital as necessary for physician to provide services to Members hereunder; and, (iii) be certified and eligible to participate in the Medicare Program. Group further represents and warrants that: (iv) each non-physician Group Provider shall maintain a current and unrestricted license to practice his/her profession or provide the contracted service; and, (v) use of any physician extender shall be in strict compliance with the rules of the California Medical Board. (e) Each Group Physician shall authorize each hospital at which he/she maintains staff privileges to notify Blue Shield should any disciplinary or other action of any kind be initiated against such physician which could result in any suspension, reduction, or modification of his/her hospital privileges.

Standards For Provision of Care. (a) Group and Group Providers shall maintain facilities and equipment which meet all applicable legal requirements, including accessibility, and which otherwise comply with the provider credentialing requirements developed by Blue Shield for such providers, as more fully described in the Provider Manual. Accessibility shall include compliance with the requirements of the Americans With Disabilities Act. (b) To assist Group in meeting Blue Shield requirements hereunder, Group shall, through a duly designated representative, attend occasional provider education/orientation sessions conducted by Blue Shield. (c) In providing Capitated Professional Services hereunder Group shall utilize only Group Providers who are credentialed and re-credentialed in accordance with Blue Shield’s standards as set forth in the Provider Manual, unless the Medically Necessary service is not available from a Group Provider. Group and/or each Group Provider shall provide to Blue Shield, on request, credentialing information, in such form as reasonably required by Blue Shield. (d) Group represents and warrants that during the term of this Agreement, each physician through whom it will provide Capitated Professional Services hereunder shall: (i) maintain a current, unrestricted license to practice medicine in California; and, (ii) maintain such staff privileges with at least one Blue Shield Hospital as necessary for physician to provide services to Members hereunder; and, (iii) be certified and eligible to participate in the Medicare Program. Group further represents and warrants that: (iv) each non-non- physician Group Provider shall maintain a current and unrestricted license to practice his/her profession or provide the contracted service; and, (v) use of any physician extender shall be in strict compliance with the rules of the California Medical Board. (e) Each Group Physician shall authorize each hospital at which he/she maintains staff privileges to notify Blue Shield should any disciplinary or other action of any kind be initiated against such physician which could result in any suspension, reduction, or modification of his/her hospital privileges.