(1) In addition to any other applicable requirements of this part 7, a contract between a carrier and an intermediary shall satisfy all the requirements of this section.
Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of section 10-16-705.
The responsibility to ensure that participating providers have the capacity and legalauthority to furnish covered benefits shall be retained by the carrier.
A carrier shall have the right to approve or disapprove participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits to the carrier's covered persons.
A carrier shall maintain copies of all intermediary health care subcontracts.
If applicable, an intermediary shall transmit utilization documentation and claimspaid documentation to the carrier. The carrier shall monitor the timeliness and appropriateness of payments made to participating providers and health care services received by covered persons.
If applicable, an intermediary shall maintain books, records, financial information,and documentation of services provided to covered persons at the intermediary's place of business in this state.
An intermediary shall allow the commissioner access to the intermediary's books,records, financial information, and any documentation of services provided to covered persons as necessary to determine compliance with this part 7.
A carrier shall have the right, in the event of the intermediary's insolvency, to requirethe assignment to the carrier of the provisions of a participating provider's contract addressing the provider's obligation to furnish covered services.
Source: L. 97: Entire part added, p. 1331, § 2, effective July 1.