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Records and Information


     As independent contracting parties, Health Plan and Medical Group maintain separate and independent governing bodies and management, and each has full authority and responsibility regarding its organization and operations.  However, the nature of the Medical Care Program is such that efficient operations require an exchange of information between Health Plan and Medical Group and full cooperation regarding policies and major decisions of Health Plan and Medical Group in all matters affecting the Medical Care Program, arrangements for Medical and Hospital Services, and necessary facilities.  The following arrangements are made in furtherance of these purposes.

Section H-1.     Sharing Information

     Medical Group and Health Plan will exchange information regarding matters relating to or connected with the Medical Care Program, including administration of this Agreement and of Membership Contracts.  The following provisions of this Article illustrate and do not limit this principle.


Section H-2.     Membership Records

     Health Plan will maintain records and establish and adhere to procedures required to determine the number of Members entitled to Medical Services under this Agreement and to permit Medical Group conveniently to identify Members.  Medical Group will cooperate with Health Plan in connection with such records and procedures in order that necessary determinations regarding eligibility for Hospital and Medical Services and the amount of compensation payable to Medical Group under this Agreement may be accomplished with maximum efficiency and minimum administrative cost.

Section H-3.     Patients' Records

     For each patient to whom it renders Medical Services, Medical Group will provide Health Plan all information and items necessary to make up, and Health Plan will make up, maintain and timely make available to Medical Group, a medical record in such form and detail as is customary among physicians in the Service Area.  Health Plan will have custody of these records, which will be the property of Medical Group, but which may be inspected and used by Health Plan in connection with all matters relating to Claims, and with respect to other matters arising in connection with the administration of Membership Contracts to the fullest extent consistent with maintaining the confidences of patients as required by physician-patient and hospital-patient relationships.  If this Agreement is terminated, Health Plan will return custody of these records to Medical Group on request, but Health Plan may make copies of the records and transfer them to health care providers or others who may be expected to render or contract with others to render medical services to Members, and for the purposes and subject to limitations mentioned in the preceding sentence.  Health Plan will make arrangements with Hospitals to assure that medical records of Medical Group patients maintained by facilities providing Hospital Services are maintained and available to Medical Group, and Medical Group will cooperate with Hospitals in maintaining such records.

Section H-4.     Financial and Accounting Records

     Both Health Plan and Medical Group will maintain complete financial and accounting records on an accrual basis in accord with generally accepted accounting principles sufficient for prompt and proper determination of Program Revenue, Net Program Revenue and all other matters of a financial or accounting nature required for the proper administration of this Agreement.

Section H-5.     Statistical Records

     Health Plan and Medical Group will cooperate in keeping statistical records relating to Medical Services, Hospital Services, Health Plan utilization and other matters required for the proper administration of the Medical Care Program.

Section H-6.     Inspection of Records and Facilities

     Health Plan and Medical Group will have the right to inspect accounting and administrative books and records maintained, and facilities owned or operated by the other party at all reasonable times insofar as such books, records and facilities relate to the conduct of the Medical Care Program.

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