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2021-074B
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Last modified
6/22/2021 12:13:29 PM
Creation date
6/11/2021 3:23:37 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/11/2021
Control Number
2021-074B
Agenda Item Number
12.D.1.
Entity Name
Employer Direct Healthcare, LLC
Subject
Surgeryplus Services Agreement
Addition of SurgeryPlus Benefit as Optional Benefit
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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />ARTICLE 2. <br />ROLE AND RESPONSIBILITIES OF EDH <br />2.1 Network Services. EDH will assist and support Sponsor in communicating the availability of <br />the Network and Network Services to Participants. EDH will offer the Network to all Participants, and EDH will <br />provide the applicable Network Services for any Participant seeking to utilize the Network for an Episode of <br />Care. <br />2.2 Provider Requirements. <br />(a) Credentials. EDH will require each Provider to cooperate and comply with EDH's <br />credentialing program. Such credentialing program will require Providers to be registered or otherwise <br />qualified in accordance with applicable law and, when applicable to a Provider's role in care processes, to meet <br />accreditation standards, including without limitation, those of the National Committee for Quality Assurance, <br />Joint Commission, or Det Norske Veritas. EDH's credentialing program may also include a review of, as <br />applicable: (i) specialized training, board certification, and fellowships in applicable fields; (ii) relevant and <br />available criminal history; (iii) malpractice claims; (iv) medical board or state licensure sanctions; (v) when <br />applicable, the Provider's procedure -specific treatment and care protocols; and (vi) any other publicly available <br />records. EDH may require Providers to provide EDH with documentation and/or primary sources evidencing <br />such credentialing, and may require Providers to comply with additional credentialing practices and programs. <br />EDH will be responsible for verifying that each Provider satisfies all applicable credentialing requirements. <br />(b) Information Regarding Providers. EDH shall require Providers to provide EDH with <br />contact information (including but not limited to telephone number, fax number, mailing address, <br />physical address, and email address) and to notify EDH of any changes to such contact information. EDH <br />shall not be responsible for verifying the accuracy or completeness of such information. EDH shall further <br />require each Provider to provide EDH with accurate and complete information regarding the qualifications, <br />certifications, and licensure of the Provider, and EDH may verify any such information by comparing it with <br />information which may be found in publicly available provider data repositories (e.g., State medical board <br />sources and/or Council for Affordable Quality Healthcare profiles). Upon reasonable request, and to the extent <br />legally permissible, EDH shall provide any such information to Sponsor. <br />2.3 Utilization and Quality Assurance. <br />(a) Education and Communication. EDH will provide Sponsor with proposed promotional <br />and educational materials designed to raise Participant awareness of availability of the Network and Network <br />Services. As set forth in Section 3.4 below, the Parties shall cooperate to distribute any such promotional and <br />educational materials to Participants. EDH shall maintain copies of all promotional and educational materials. <br />(b) Notices to Participants. EDH will provide a written notice approved by Sponsor to all <br />Participants advising them of the identity of, and relationship among EDH, the Participant, and Sponsor. <br />(c) Participant Reports. Following appropriate HIPAA requirements and standards for <br />the transfer of information relating to any Participant, EDH will provide Sponsor (or any designee of Sponsor <br />who has executed a mutually agreeable confidentiality agreement with EDH) with the following monthly <br />reports: (a) utilization of the Network and Network Services by Participants and (b) available and/or applicable <br />outcome and pricing information relating to Participants utilizing the Network and Network Services for an <br />Episode of Care. Upon reasonable written request, EDH will provide Sponsor access to pertinent substantiating <br />documentation maintained by EDH and required in connection with such reports, subject to the confidentiality <br />requirements contained in Article 6 of this Agreement. Any modifications requested by Sponsor to the reports <br />listed in this Section 2.3(c) shall be subject to a reasonable fee mutually agreed in writing by the Parties to <br />reflect the time and resources necessary to fulfill such request. <br />
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