354.621. Intermediary and participating provider requirements. - Missouri Statutes

Intermediary and participating provider requirements.

354.621. 1. Intermediaries and participating providers with whomthey contract shall comply with all the applicable requirements of sections354.600 to 354.636.

2. A health carrier's statutory responsibility to monitor theoffering of covered benefits to enrollees shall not be delegated orassigned to the intermediary.

3. If applicable, an intermediary shall transmit utilizationdocumentation and claims paid documentation to the health carrier. Thecarrier shall monitor the timeliness and appropriateness of payments madeto providers and health care services received by enrollees.

4. If applicable, an intermediary shall maintain the books, records,financial information and documentation of services provided to enrolleesat its principal place of business in the state and preserve them for fiveyears in a manner that facilitates regulatory review.

5. An intermediary shall allow a health carrier or the directoraccess to the intermediary's books, records, financial information and anydocumentation of services provided to enrollees, as necessary to determinecompliance with sections 354.600 to 354.636.

6. A health carrier shall have the right, in the event of theintermediary's insolvency, to require the assignment to the health carrierof the provisions of a provider's contract addressing the provider'sobligation to furnish covered services.

(L. 1997 H.B. 335)