D.C. Mun. Regs. tit. 26, r. 26-A4706
This section is only applicable to the extent that a health carrier, provider, or medical group uses an intermediary.
A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section.
Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of § 4705 of this chapter.
A health carrier shall have the right to disapprove the participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits.
A health carrier shall maintain copies of all intermediary health care subcontracts at its principal place of business in the District of Columbia or ensure that it has access to all intermediary subcontracts, including the right to make copies to facilitate regulatory review, and provide copies of those subcontracts to the Commissioner within twenty (20) days of receiving a request to furnish them.
If applicable, an intermediary shall transmit utilization documentation and claims paid documentation to the health carrier. A carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by covered persons.
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 District of Columbia and preserve them for seven (7) years.
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 determine compliance with this chapter.
In the event of the intermediary's insolvency, a health carrier shall have the right to require that the provisions of the provider contract addressing the provider's obligation to furnish covered services be assigned to the health carrier, and the health carrier shall then be obligated to pay the provider for furnishing covered services under the same terms and conditions as the intermediary prior to the insolvency.
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 chapter.
D.C. Mun. Regs. tit. 26, r. 26-A4706