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collection activities, obtaining payment under a contract for reinsurance (including stop-loss <br /> insurance and excess of loss insurance),and related health care data processing; (4) review of <br /> health care services with respect to medical necessity, coverage under a health plan, <br /> appropriateness of care, or justification of charges; (5) utilization review activities, including <br /> precertification and preauthor€nation of services, concurrent and retrospective review of <br /> services;and(6)disclosure to consumer reporting agencies of information relating to collection <br /> of premiums or reimbursement. <br /> iv. Public Health. Public Health means the activities described in 45 C.F.R.§164.512(b). <br /> v. Research. Research means a systematic investigation, including development, testing, and <br /> evaluation, designed to contribute to generalizable knowledge. <br /> vi. Administration. Administration means carrying out N3CN's proper management and oversight <br /> of its Data Platform and its responsibilities under the 2019 PRIMARY CARE CASE MANAGEMENT <br /> SERVICES CONTRACT#37751 BETWEEN THE NORTH CAROLINA DEPARTMENT OF HEALTH AND <br /> HUMAN SERVICES DIVISION OF HEALTH BENEFITS AND NORTH CAROLINA COMMUNITY CARE <br /> NETWORKS, INC. or any successor agreement for accessing and using State-owned data, this <br /> Agreement, and Applicable Law, Applicable Law, this Agreement, and any other agreement <br /> between N3CN and any third party for accessing and using Data through the Data Platform. <br /> Without limiting the generality of the foregoing,Administration also includes performing record <br /> maintenance, conducting or assisting in audits permitted or required,evaluating performance <br /> of the Data Platform,conducting technical system support on the Data Platform and the Data, <br /> carrying out N3CN's and Participant's functions and obligations under this Agreement(including <br /> any necessary data extractions from Participant's systems and applications),and all applicable <br /> BAAs, other agreements, and policy and procedure documents, and all other activities <br /> authorized by the N3CN Board of Directors consistent with Applicable Law. <br /> w. Person. "Person" means both a Natural Person and any entity managed by Natural Persons, <br /> except where Person is part of the term"Natural Person". <br /> x. Personally Identifiable Information ("PIl"). "PII" means a Natural Person's first name or initial <br /> followed by their last name in combination with identifying information as defined in North <br /> Carolina General Statute§14-113.20(b),other than email addresses and related internet account <br /> information. <br /> V. Protected Health information ("PHI"). "PHI" means individually identifiable heath information <br /> that is:(i)Transmitted by electronic media;(€€)Maintained in electronic media;or(iii)Transmitted <br /> or maintained in any other form or medium. <br /> z. Provider Services. "Provider Services" refer to activities that support healthcare providers <br /> participating in the PCCM Program,including Practice Support,Behavioral Health Integration,and <br /> Pharmacy Support. <br /> aa. Representative. "Representative" includes any employee, contractor, agent, officer, or <br /> consultant of a Party,including any Affiliate. <br /> bb. Required by Law. "Required by Law"has the meaning ascribed to this term in 45 C.F.R.§164.103, <br /> cc. State. "State" refers to the State of North Carolina, including all administrative agencies involved <br /> in the management of Medicaid and Health Choice data,populations,and programs. <br /> Page 5 of 21 <br />