Scope of Work / Contractor Obligations A. Licensing. Contractor will make application for, obtain, and continuously maintain in good standing all licenses and permits necessary to perform its obligations under this Agreement in the State of New Mexico. B. Initial Provider Network. The Contractor has contracted or will contract with qualified, licensed, and credentialed medical providers to deliver medical services for the Agency. Following the approval by Contractor of the Plan Description provided to Contractor, these network providers will be available to provide medical services to Members in accordance with the Plan. C. Network Provider Management. Prior to contracting with a medical provider, Contractor will use reasonable diligence to ensure that medical providers qualifications established by the Contractor. During the term of this Agreement, Contractor will administer a recredentialing program designed to periodically re-examine each network provider’s satisfaction of criteria and qualifications established by the Contractor. Contractor is hereby authorized, without the consent of the Agency, to add and/or delete the names of network providers contracted. Significant additions and/or deletions (“significant” defined as +/-5%) will be communicated by Contractor to the Agency as quickly as possible, at least monthly. In addition to ongoing network provider communication, Contractor will distribute to all network providers communications initiated by the Agency relating to the Plan. In addition, Contractor will provide copies of the ongoing network provider communications to the Agency. The Contractor will have a dedicated team to address the Members’ quality of care complaints regarding individual network providers. The Agency reserves the right to request termination of a network provider, based on evidence. The Contractor agrees the provider network offered to the Members may differ from the provider networks offered by Contractor to other employer groups. The Contractor agrees that if network provider discounts, or fee maximums in Contractor’s New Mexico provider networks include variations by client or account, Contractor will also extend to the Agency, if appropriate, similar negotiated payment arrangements, except that this provision does not interfere with Contractor’s responsibilities in section 2.D.2 of this Agreement.
