Manage the medical and health care needs of members, including monitoring and following up on care provided by      other providers, providing coordination necessary for services provided by specialists and ancillary providers (both       in and out-of-network), and maintaining a medical record meeting IntegraNet standards

Provide coverage 24 hours a day, 7 days a week; regular hours of operation should be clearly defined and        communicated to members

Provide all services ethically, legally and in a culturally competent manner, and meet the unique needs of members       with special health care needs

Participate in systems established by IntegraNet to facilitate the sharing of records, subject to applicable        confidentiality and HIPAA requirements

Make provisions to communicate in the language or fashion primarily used by his or her assigned members

Provide hearing interpreter services on request to members who are deaf or hard of hearing

Participate in and cooperate with IntegraNet in any reasonable internal and external quality assurance, utilization       review, continuing education and other similar programs established by IntegraNet

Comply with Medicare laws, regulations and CMS instructions, agree to audits and inspections by CMS and/or its       designees, cooperate, assist and provide information as requested, and maintain records for a minimum of 10 years

Participate in and cooperate with the IntegraNet appeal and grievance procedures

Agree to not balance bill members for monies that are not their responsibility or that should be paid for by another    carrier (in the case of a dually-eligible member covered both by Medicare and Medicaid, federal law requires     providers may bill only the member’s health plan or the state Medicaid agency for copays or other cost-sharing       amounts. Providers may not bill such members for cost sharing.)

Continue care in progress during and after termination of a member’s contract for up to 60 days, or such longer      period of time required by state laws and regulations, until a continuity of service plan is in place to transition the    member to another network provider or through postpartum care for pregnant members in accordance with       applicable state laws and regulations.

Comply with all applicable federal and state laws regarding the confidentiality of patient records

Develop and have an exposure control plan in compliance with Occupational Safety and Health Administration       (OSHA) standards regarding blood-borne pathogens

Establish an appropriate mechanism to fulfill obligations under the Americans with Disabilities Act of 1990 (ADA)

Support, cooperate and comply with IntegraNet Quality Improvement program initiatives and any related policies       and procedures to provide quality care in a cost-effective and reasonable manner

Inform IntegraNet if a member objects to the provisions of any counseling, treatments or referral services for       religious reasons

Treat all members with respect and dignity, provide appropriate privacy, and treat member disclosures and records       confidentially, giving members the opportunity to approve or refuse their release

Provide members complete information concerning their diagnosis, evaluation, treatment and prognosis and give       them the opportunity to participate in decisions involving their health care, except when contraindicated for medical       reasons

Advise members about their health status, medical care or treatment options, regardless of whether benefits for       such care are provided under the program and advise them on treatments that may be self-administered

When clinically indicated, contact members as quickly as possible for follow up regarding significant problems       and/or abnormal laboratory or radiological findings

Have a policy and procedure to ensure proper identification, handling, transport, treatment and disposal of        hazardous and contaminated materials and wastes to minimize sources and transmission of infection

Agree to maintain communication with the appropriate agencies such as local police, social services agencies and       poison control centers to provide high-quality patient care

Agree any notation in a member’s clinical record indicating diagnostic or therapeutic intervention as part of the       clinical research will be clearly contrasted with entries regarding the provision of nonresearched-related care

Participate in the interdisciplinary care team meetings when necessary

If a member self-refers or a provider is referring to another provider, that provider is responsible for checking the   IntegraNet provider directory to ensure the specialist is in the network. Referrals to IntegraNet-contracted     specialists do not require precertification, all referrals to providers outside IntegraNet require precertification unless   urgent or emergent services are needed. Some procedures performed by specialist physicians may require    precertification. Please refer to the Summary of Benefits document for procedures that require precertification or     call 281-591-5289. If you cannot locate a provider in the IntegraNet network, you should contact 833-908-0105. You   must obtain authorization from IntegraNet before referring members to noncontracted providers. Additionally,     certain services/procedures require precertification from IntegraNet.

Provide advanced notification to members of services that are not covered by the plan or Medicare in accordance      with Medicare requirements.