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<br /> <br /> Page 31 of 48 <br />the claim per § 58-3-225 (d). The Payor shall reprocess medical and pharmacy claims in a timely and accurate manner <br />as described in this provision (including interest and penalties if applicable). <br /> <br />(d) If the Payor fails to pay a Clean Claim in full pursuant to this provision, the Payor shall pay <br />interest and penalty. Late Payments will bear interest at the annual rate of eighteen (18) percent beginning on the <br />date following the day on which the claim should have been paid or was underpaid. <br /> <br />(e) Failure to pay a Clean Claim within thirty (30) days of receipt will result in the Payor paying <br />Provider a penalty equal to one (1) percent of the total amount of the claim per day beginning on the date following <br />the day on which the claim should have been paid or was underpaid. <br /> <br />(f) The Payor shall pay the interest and penalty from subsections (e) and (f) as provided in that <br />subsection, and shall not require Provider to requests the interest or the penalty. <br /> <br />10.3 Government Funds. Participating Provider and WellCare acknowledge that funds used for provider <br />payments are government funds. (Section VII, G (1)(s)). <br /> <br />11. Data to Provider. WellCare will provide certain data and information to the Provider, and changes to such <br />information, which may include performance feedback report if compensation is related to efficiency criteria, <br />information on benefit exclusions, administrative and utilization management requirements; credential verification <br />programs; quality assessment programs; and provider sanction policies (Section VII, G(1)(n)). <br /> <br />12. Provider Directory. Participating Provider authorizes WellCare and/or Payor to include, and WellCare and/or <br />Payor shall include, the name of Participating Provider and/or Participating Provider’s group in the provider directory <br />distributed to Covered Persons. (Section VII, G (1)(p)). <br /> <br />13. Assignment. Participating Provider shall not assign, delegate, or transfer any of its duties and/or <br />responsibilities under the Agreement without prior written consent of WellCare. WellCare shall notify Provider in <br />writing of any duties or obligations that are to be delegated or transferred, before the delegation or transfer. (Section <br />VII, G (1)(r)). <br /> <br />14. Providers of Perinatal Care. To the extent that Participating Provider offers prenatal, perinatal, and <br />postpartum services or is an obstetrician, Participating Provider shall comply with NC DHHS’s Pregnancy <br />Management Program. The Pregnancy Management Program is a set of mandatory standards and clinical initiatives <br />aimed at improving the quality of pregnancy care, improving maternal and infant outcomes and reducing health care <br />costs among participating providers. Participating Provider shall: (a) complete the standardized risk-screening tool <br />at each initial visit; (b) allow WellCare or WellCare’s designated vendor access to medical records for auditing <br />purposes to measure performance on specific quality indicators; (c) commit to maintaining or lowering the rate of <br />elective deliveries prior to thirty-nine (39) weeks gestation; (d) commit to decreasing the cesarean section rate among <br />nulliparous women; (e) offer and provide 17 alpha-hydroxyprogesterone caproate (17p) for the prevention of preterm <br />birth to women with a history of spontaneous preterm birth who are currently pregnant with a singleton gestation; (f) <br />complete a high-risk screening on each pregnant Medicaid Managed Care Covered Person in the program and <br />integrate the plan of care with local pregnancy care management; (g) decrease the primary cesarean delivery rate if <br />the rate is over NC DHHS’s designated cesarean rate (NC DHHS will set the rate annually at or below 20%); and (h) <br />ensure comprehensive post-partum visits occur within fifty-six (56) days of delivery (Section VII, G(1)(u)) and M(3)). <br /> <br />14.1 High-Risk Pregnancies Information Requirement. Participating Provider shall send all screening <br />information and applicable medical record information for Covered Persons in the Care Management of High-Risk <br />Pregnancies to WellCare and the Local Health Departments or other applicable local care management entities that <br />are contracted for the provision of providing care management services for high risk pregnancy within one business <br />day of the provider completing the screening (Section VII, M(3.3.i.)). <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210