West Virginia Code § 33-55-5

Intermediaries
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A contract between a health carrier and an intermediary shall satisfy all the requirements
contained in this section.
(a) A health carrier's statutory responsibility to monitor the offering of covered benefits to
covered persons may not be delegated or assigned to the intermediary.
(b) A health carrier has the right to approve or disapprove participation status of a
subcontracted provider in its own or a contracted network for the purpose of delivering
covered benefits to the carrier's covered persons. u
(c) A health carrier shall maintain copies of all intermediary health care subcontracts at its
principal place of business in the state, or ensure that it has access to all intermediary
subcontracts, including the right to make copies to facailitate regulatory review, upon 20 days
prior written notice from the health carrier.
(d) If applicable, an intermediary shall transmit utilization documentation and claims-paid
documentation to the health carrier. The carrier shall monitor the timeliness and
appropriateness of payments made to proviiders and health care services received by
covered persons.
(e) If applicable, an intermediary shall maintain the books, records, financial information,
and documentation of services provided to covered persons at its principal place of business
in the state and preserve them for two years in a manner that facilitates regulatory review.
(f) An intermediary shall allow the commissioner access to the intermediary's books, records,
financial information , and any documentation of services provided to covered persons, as
necessary to dVetermine compliance with this article.
(g) A health carrier has the right, in the event of the intermediary's insolvency, to require
the assignment to the health carrier of the provisions of a provider's contract addressing the
provider's obligation to furnish covered services. If a health carrier requires assignment, the
health carrier remains obligated to pay the provider for furnishing covered services under
the same terms and conditions as the intermediary prior to the insolvency.
(h) Notwithstanding any other provision of this section, to the extent the health carrier
delegates its responsibilities to the intermediary, the carrier shall retain full responsibility
for the intermediary's compliance with the requirements of this article.

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