Health Net 2009 Annual Report Download - page 532

(f) maintain a record of any appeals and grievances with respect to the Administered Contracts in accordance with
applicable requirements of Governmental Entities and provide a copy of such log upon Company’s request; and
(g) comply in all material respects with all applicable Laws of any Governmental Entity related to Claims processing or
payment, including prompt pay Laws.
ARTICLE VII.
REGULATORY AND LEGAL PROCEEDINGS
Section 7.1. Regulatory Complaints and Proceedings.
(a) From and after the Effective Date, but subject to Section 2.3, the Administrator shall:
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(i) respond to any Claims payment related complaints or investigations made by any Governmental Entity with
respect to the Business (including relating to Contract Holder or Provider payment complaints or assertions of
improper or unfair practices and procedures) within the Governmental Entity’s requested time frame for
response (including any extensions thereof) or, if no such time frame is provided, within the time frame as
allowed by applicable Law; provided, that, subject to meeting such time frames (including any extensions
thereof), if the complaint or investigation involves a material issue, the Administrator shall provide promptly a
copy of such response to the Company for its prior review, reasonable comment (which the Administrator shall
substantially incorporate into any response) and reasonable approval; provided, further, that if the time frame
for response makes the Company’s prior review impractical, the Administrator shall promptly provide a copy
of such response to the Company after submitting such response;
(ii) promptly notify the Company of any written non-Claims payment related complaints or investigations initiated
by a Governmental Entity with respect to the Business and relating to a material issue and of any proceedings
(either Claims or non-Claims related) initiated by a Governmental Entity with respect to the Business, and
prepare and send to the Governmental Entity, with a copy to the Company, a response within the
Governmental Entity’s requested time frame for response (including any extensions thereof) or, if no such time
frame is provided, within the time frame as allowed by applicable Law; provided, that, subject to meeting such
time frames (including any extensions thereof), if the complaint or investigation involves a material issue, the
Administrator shall provide promptly any response to the Claims or non-Claims related complaints or
investigations to the Company for its prior review, reasonable comment (which the Administrator shall
substantially incorporate into any response) and reasonable approval; provided, further, that if the time frame
for response makes the Company’s prior review impractical, the Administrator shall promptly provide a copy
of such response to the Company after submitting such response;