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<br /> <br /> Page 29 of 48 <br />(c) If Participating Provider is a PCP providing services for routine/check-up without symptoms, <br />appointment wait time shall not exceed thirty (30) calendar days. <br /> <br />(d) If Participating Provider is a PCP providing after-hours access for emergent and urgent care, <br />care shall be administered immediately upon presentation at a service delivery site. <br /> <br />(e) If Participating Provider provides prenatal care, appointment wait time for initial <br />appointments within the first or second trimester shall not exceed fourteen (14) calendar days and appointment wait <br />time for initial appointments within the third trimester or for a high-risk pregnancy shall not exceed five (5) calendar <br />days. <br /> <br />(f) If Participating Provider provides specialty care, appointment wait time shall not exceed <br />twenty-four (24) hours for urgent care services or thirty (30) calendar days for routine/check-up without symptoms <br />services. For after-hours access for emergent and urgent care, care shall be administered immediately upon <br />immediately upon presentation at a service delivery site. <br /> <br />(g) If Participating Provider provides behavioral health care, appointment wait time shall not <br />exceed thirty (30) minutes for Mobile Crisis Management Services; twenty-four (24) hours for Urgent Care Services <br />for Mental Health or Urgent Care Services for SUDs; and fourteen (14) calendar days for Routine Services for Mental <br />Health or Routine Services for SUDs. For Emergency Services for Mental Health or SUDs, care should administered <br />immediately upon presentation at a service delivery site. <br /> <br />(h) To the extent Participating Provider performs Emergency Services, Participating Provider <br />shall make Emergency Services available twenty-four (24) hours a day, three hundred sixty-five (365) days a year. <br /> <br />8. Records. <br /> <br />8.1 Medical Records. Participating Provider shall maintain confidentiality of Covered Person medical <br />records and personal information and other health records as required by law. Participating Provider shall maintain <br />adequate medical and other health records according to industry and WellCare standards. Participating Provider shall <br />make copies of such records available to WellCare, Payor and NC DHHS in conjunction with its regulation of <br />WellCare. Participating Provider shall make available and furnish the records immediately upon request in either <br />paper or electronic form, at no cost to the requesting party. (Section VII, G(1)(k)). <br /> <br />8.2 Access to Provider Records. <br /> <br />(a) Participating Provider agrees to provide at no cost to the following entities or their designees <br />with prompt, reasonable, and adequate access to WellCare or Payor and the Agreement and any records, books, <br />documents, and papers that relate to WellCare or Payor and the Agreement and/or Participating Provider’s <br />performance of its responsibilities under this Agreement for purposes of examination, audit, investigation, contract <br />administration, the making of copies, excerpts or transcripts, or any other purpose NC DHHS deems necessary for <br />contract enforcement or to perform its regulatory functions: (i) the United States Department of Health and Human <br />Services or its designee; (ii) the Comptroller General of the United States or its designee; (iii) NC DHHS, its Medicaid <br />managed care program personnel, or its designee; (iv) the Office of Inspector General; (v) North Carolina Department <br />of Justice Medicaid Investigations Division; (vi) any independent verification and validation contractor, audit firm, <br />or quality assurance contractor acting on behalf of NC DHHS; (vii) the North Carolina Office of State Auditor, or its <br />designee; (viii) a state or federal law enforcement agency; and (ix) any other state or federal entity identified by NC <br />DHHS, or any other entity engaged by NC DHHS. <br /> <br />(b) Participating Provider shall cooperate with all announced and unannounced site visits, <br />audits, investigations, post-payment reviews, or other program integrity activities conducted by the NC DHHS. <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210