§ 10-16-706 — Intermediaries

(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.

(2) Intermediaries and participating providers with whom they contract shall
comply with all the applicable requirements of section 10-16-705.

(3) The responsibility to ensure that participating providers have the
capacity and legal authority to furnish covered benefits shall be retained by the
carrier.

(4) 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.

(5) A carrier shall maintain copies of all intermediary health-care
subcontracts.

(6) If applicable, an intermediary shall transmit utilization documentation
and claims paid 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.

(7) 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.

(8) 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.

(9) A carrier shall have the right, in the event of the intermediary's
insolvency, to require the assignment to the carrier of the provisions of a
participating provider's contract addressing the provider's obligation to furnish
covered services.

Legislative History

Source: L. 97: Entire part added, p. 1331, � 2, effective July 1.