AMENDMENT TO THE PARTICIPATING DENTISTAGREEMENT FOR RENDERING DENTAL SERVICES UNDER MI SALUD PROGRAM

Triple-S Salud (TSS) and the Puerto Rico Health Insurance Administration (ASES, for its Spanish acronym) have signed an Agreement for the administration of certain service regions the Puerto Rico Government Health Plan, known as the Mi Salud Program which will be effective November 1, 2011. (“Mi Salud Contract”) This Circular Letter is to amend the Contract between Triple-S Salud, Inc. and the Participating Dentist to incorporate regulatory and program requirements established by ASES for the rendering of dental services under the Mi Salud Program. This Addendum provides the basis to ensure compliance with the standards of odontology, with a continued emphasis on prevention, quality and access to clinical services inherent to Mi Salud Health Plan. In addition, this document contains the general provisions required for provider participation in the Plan, in accordance with Mi Salud Contract. The Parties agree that they accept this Addendum, consent to and promise to abide by each and every one of the clauses set forth, with its corresponding Attachments, as amended conforming to the requirement set forth for the participation in the new model for the rendering of services under Mi Salud program

Socorro Rivas-Rodríguez President and CEO Triple-S Salud, Inc. DENTIST’S NAME: _________________________ NPI NO. ____________________ PROVIDER TYPE: _DENTISTS__________________ DATE ____________________________

The Participating Dentist must comply with the following terms and conditions:

ARTICLE I DEFINITIONS

The following terms have the respective meaning set forth below, unless the context clearly requires otherwise.

Act 72: The law of the Government of Puerto Rico, adopted on September 7, 1993, and subsequently amended, which created the Puerto Rico Health Insurance Administration (ASES) and empowered ASES to administer certain government health programs.

Abuse: Provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary cost to the Mi Salud Program, or in reimbursement for services that are not necessary or that fail to meet professionally accepted standards for Dental Care. It also includes Enrollee practices that result in unnecessary cost to the Medicaid program.

Access: Adequate availability of Benefits to fulfill the needs of Enrollees.

Action: The denial or limited authorization of a requested service, including the type or level of service; the reduction, suspension, or termination of a previously authorized service; the denial, in whole or part, of payment for a service (including in circumstances in which an Enrollee is forced to pay for a service; the failure to provide services in a timely manner (within the timeframes established by this Contract or otherwise established by ASES); or the failure of Triple-S to act within the timeframes provided in 42 CFR 438.408(b). ADFAN: Families and Children Administration (Administración de Familias y Niños), which is responsible for foster care children in the custody of the Government of Puerto Rico. Administrative Law Hearing: The appeal process administered by the Government of Puerto Rico and as required by federal law, available to Enrollees and Providers after they exhaust the applicable grievance system and complaint process. Advance Directive: A written instruction, such as a living will or durable power of attorney for Health Care, as defined in 42 CFR 489.100, and as recognized under Puerto Rico law under Act 160 of November 17, 2001, as amended, relating to the provision of health care when the individual is incapacitated.

Agent: An entity that contracts with ASES to perform administrative services, including but not limited to: fiscal agent activities; outreach, eligibility, and Enrollment activities; and Information Systems and technical support.

Amendment: Means this Addendum Triple-S’ Master Contract, including the

Circular Letter and the Dental Services Contract Addendum attached to it

Appeal: An Enrollee request for a review of an Action.

ASES: Administración de Seguros de Salud de Puerto Rico (the Puerto Rico Health Insurance Administration), the entity in the Government of Puerto Rico responsible for oversight and administration of the Mi Salud Program, or its Agent.

ASES Data: All data created from information, documents, messages (verbal or electronic), Reports, or meetings involving or arising out of this Contract, except for Triple-S Proprietary Information, including its logo, its trademark, and any and all information generated by TSS as a result of its administrator’s functions under the TSS-ASES Agreement..

ASSMCA: Administración de Servicios de Salud Mental y Contra la Adicción (the Puerto Rico Mental Health and Anti-Addiction Services Administration), the government agency responsible for the planning and establishment of mental health and substance abuse policies and procedures and for the coordination, development, and monitoring of all behavioral health services rendered to Enrollees in Mi Salud.

Authorized Signatory: An individual designated by Triple-S who is either Triple-S’ Chief Executive Officer, Triple-S’ Chief Financial Officer, or an individual who has delegated authority to sign for, and who reports directly to, Triple-S’ Chief Executive Officer or Chief Financial Officer as authorized by a corporate resolution (“resolución corporativa”).

Basic Coverage: The Mi Salud Dental Covered Services listed in Section 7.5 of the Agreement between ASES and Triple St, which are available to all Enrollees.

Benefits: The services set forth in this Contract, including Basic Coverage, Dental Services and Special Coverage for which Triple-S has agreed to provide Administrative Services.

Business Days: Traditional workdays, including Monday, Tuesday, Wednesday, Thursday, and Friday. Puerto Rico holidays are excluded.

Calendar Days: All seven days of the week.

Call Center: A telephone service facility equipped to handle a large number of inbound and outbound calls. Case Management: An Administrative Service comprised of a set of Enrollee-centered steps to ensure that an Enrollee with intensive needs, including catastrophic or high-risk conditions, receives needed services in a supportive, effective, efficient, timely, and cost-effective manner.

Centers for Medicare and Medicaid Services: The agency within the U.S. Department of Health and Human Services with responsibility for the Medicare, Medicaid, and the Children’s Health Insurance Programs.

Central Access Units: Clinics that serve as points of entry for Enrollees seeking to access Behavioral Health Services, which are staffed by an interdisciplinary team responsible for referring Enrollees to the required level of treatment, and for tracking and monitoring quality in the delivery of Behavioral Health Services.

Certification: As provided in Section 4.3.3 of the Contract between ASES and Triple S, a decision by the Puerto Rico Medicaid Program that a person is eligible for services under the Mi Salud Program because the person is Medicaid Eligible, CHIP Eligible, or a member of the Commonwealth Population. Some public employees and pensioners may enroll in Mi Salud without first receiving a Certification.

Children’s Health Insurance Program (“CHIP”): The Government of Puerto Rico’s Children’s Health Insurance Program established pursuant to Title XXI of the Social Security Act.

Circular Letter: It refers to the provisions included in this Circular Letter No.

M1110439-A which pertain, exclusively, to the contractual relationship between the Participating Dentist and Triple-S for Mi Salud. Also known, in Spanish, as “Carta Circular” Claim: Whether submitted manually or electronically, a bill for Covered Services, a line item of Covered Services, or all Covered Services for one Enrollee within a bill.

Claims Payment: The amount that ASES, through Triple-S, pays for Claims submitted by Providers for Covered Services provided to Enrollees under this Contract

Clean Claim: A Claim received by Triple-S for adjudication, in a American Dental Association (ADA) accepted format in compliance with standard ADA coding guidelines and which can be processed without obtaining additional information from the Provider of the service or from a Third Party as prescribed in section 22.4.5.1 of the ASES and Triple S contract. It includes a claim with errors originating in Triple-S’s claims system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse, or a claim under review for Medical Necessity. Commonwealth Population: A group eligible for participation in Mi Salud as Other Eligible Persons, with no federal participation in the cost of their coverage, which is comprised of low-income persons and other groups listed in Section 1.3.1.3.1 of the Contract between ASES and Triple S.

Complaint: The procedure for addressing Enrollee complaints, defined as expressions of dissatisfaction about any matter other than an Action that are resolved at the point of contact rather than through filing a formal grievance.

Contract: refers to the written agreement between ASES and Triple-S; comprised

of the Mi Salud Contract, any addenda, appendices, attachments, or amendments

thereto

Contract Term: The duration of time that the Contract between ASES and Triple S is in effect (including any Transition Period)

Co-Payment: A cost-sharing requirement which is a fixed monetary amount paid by the Enrollee to a Provider for certain Covered Services as specified by ASES in addition to the established procedure’s rate.

Cost Avoidance: A method of paying Claims in which the Provider is not reimbursed until the Provider has demonstrated that all available health insurance, and other sources of Third Party Liability, have been exhausted. This provision will not be enforced if dentist verifies the eligibility of the beneficiary with Triple S when providing service.

Covered Services: Those Medically Necessary dental health care services as provided in Article 7.6 and other documents related to the Mi Salud Contract between ASES and Triple S to be provided to Enrollees by Providers, the payment or indemnification of which are covered under the Mi Salud Program. .

Credentialing: Triple-S’s determination as to the qualifications of a specific Provider to render specific health care services, according with, at minimum including the criteria for credentialing required in Article 9 of Mi Salud Contract.

Cultural Competency: A set of interpersonal skills that allow individuals to increase their understanding, appreciation, acceptance, and respect for cultural differences and similarities within, among and between groups and the sensitivity to know how these differences influence relationships with Enrollees. This requires a willingness and ability to draw on community-based values, traditions and customs, to devise strategies to better meet culturally diverse Enrollee needs, and to work with knowledgeable persons of and from the community in developing focused interactions, communications, and other supports.

Daily Basis: Each Business Day

Dental Services: The dental services provided under Mi Salud Program, which are listed in Section 7.6 of Mi Salud Contract between Triple-S and ASES

Dependent: A person who is enrolled in Mi Salud as the spouse or child of the principal Enrollee.

Disenrollment: The termination of a person’s Enrollment in the Mi Salud Plan.

Dual Eligible Beneficiary: An Enrollee eligible for both Medicaid and Medicare.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program: A Medicaid-mandated program that covers screening and diagnostic services to determine physical and mental deficiencies in Enrollees less than twenty-one (21) years of age, and health care, prevention, treatment, and other measures to correct or ameliorate any deficiencies and chronic conditions discovered. It is the responsibility of the Primary Care Physician and shall refer to a dentist any new beneficiary or enrollee covered under EPSDT requirements adopted by ASES with the College of Dental Surgeons of Puerto Rico. Dentist shall comply with the provisions applicable to dental services, to the extent that such services relate to the aforementioned EPSDT program.

Eligible Person: A person eligible to enroll in the Mi Salud Program provided in Section 1.3.1 of Mi Salud Contract, by virtue of being Medicaid Eligible, CHIP Eligible, or an Other Eligible Person.

Emergency Medical Condition or Medical Emergency: A medical or mental health condition, regardless of diagnosis or symptoms, manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect to result in the following, in the absence of immediate medical attention: (i) placing the physical or mental health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (ii) seriously impairing bodily functions; or (iii) causing serious dysfunction of any bodily organ or part.

Emergency Services: Covered Services (as described in Section 7.5.9 of Mi Salud Contract) furnished by a qualified Provider in an emergency room that are needed to evaluate or stabilize an Emergency Medical Condition as defined above. Enrollee: A person who is currently enrolled in the Plan, including a Medicaid recipient who is currently enrolled in Mi Salud Program, as provided in Mi Salud Contract, and who, by virtue of relevant federal and Puerto Rico laws and regulations, is an Eligible Person listed in Section 1.3.1 of Mi Salud Contract.

Enrollment: The process by which an Eligible Person becomes a member of the Mi Salud Plan. Fee-for-Service: A method of reimbursement based on payment for specific Covered Services rendered to an Enrollee.

Fiscal Year: The period from July 1 of one calendar year through June 30 of the following calendar year.

Fraud: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit or financial gain to him/herself or some other person, and it includes any act that constitutes Fraud under applicable federal or Puerto Rico law.

Grievance: An expression of dissatisfaction about any matter other than an Action.

Grievance System: The overall system that includes Complaints, Grievances, and Appeals at Triple-S level, as well as access to the Administrative Law Hearing process.

Health Care Professional: A physician, dentist or other health care professional, including but not limited to podiatrists, optometrists, chiropractors, psychologists, dentists, physician’s assistants, physical or occupational therapists and therapists assistants, speech-language pathologists, audiologists, registered or licensed practical nurses (including nurse practitioners, clinical nurse specialist, certified registered nurse anesthetists, and certified nurse midwives), licensed certified social workers, registered respiratory therapists, and certified respiratory therapy technicians. Healthy Child Care: The battery of screenings (listed in Section 7.5.3.1 of Mi Salud Contract) provided to children under age two (2) who are Medicaid- or CHIP Eligible as part of Puerto Rico’s Early and Periodic Screening, Diagnostic and Treatment Program.

HEDIS: The Healthcare Effectiveness Data and Information Set, a set of applicable performance measures to the dental services for managed care developed by the National Committee for Quality Assurance (“NCQA”).

Health Insurance Portability and Accountability Act (“HIPAA”): A law enacted in 1996 by the Congress of the United States. When referenced in Mi Salud Contract it includes all related rules, regulations and procedures. Implementation Date of the Contract: The date on which the Provider shall first be entitled to compensation for providing Covered Services and Benefits under Mi Salud Contract, which is November 1, 2011.

Incurred-But-Not-Reported (IBNR): Estimate of unpaid Claims liability, including received but unpaid Claims.

Information Service: The component of Tele Mi Salud, a Call Center operated by Triple-S intended to assist Enrollees with routine inquiries which shall be fully staffed between the hours of 7:00 a.m. and, 7:00 p.m., Monday through Saturday , excluding Puerto Rico holidays.

Information System(s): A combination of computing and communications hardware and software that is used in: (a) the capture, storage, manipulation, movement, control, display, interchange and/or transmission of information, i.e. structured data (which may include digitized audio and video) and documents; and/or (b) the processing of such information for the purposes of enabling and/or facilitating a business process or related transaction.

Insolvent: Unable to meet or discharge financial liabilities.

Integration Model: The service delivery model under the Mi Salud Program, providing physical and behavioral health services in close coordination, to ensure

optimum detection, prevention, and treatment of physical and behavioral health conditions.

MA-10: Form issued by the Puerto Rico Medicaid Program, entitled “Notice of Action Taken,” containing the Certification decision (whether a person was determined eligible or ineligible for Medicaid, CHIP, or the Commonwealth Population).

Managed Behavioral Health Organization (“MBHO”): An entity that contracts with ASES for the provision of the behavioral health component of the Mi Salud program.

Managed Care Organization (“MCO”): An entity that is organized for the purpose of providing health care and is licensed as an insurer by the PRICO, which contracts with ASES for the provision of Covered Services and Benefits, except for Behavioral Health Services in designated Service Regions, under the Mi Salud program. For the avoidance of doubt, the Parties agree that TSS is not an MCO for purposes of Mi Salud Contract.

Marketing Materials: Materials that are produced in any medium, by or on behalf of Triple-S which can reasonably be interpreted as intended to market to individuals the Mi Salud Program.

Master Formulary: The list of pharmaceutical products set forth for the Mi Salud Enrollees.

Medicaid: The joint federal/state program of medical assistance established by Title XIX of the Social Security Act.

Medicaid Eligible Person: An individual eligible to receive services under Medicaid, who is eligible, on this basis, to enroll in the Mi Salud Program.

Medicaid Management Information System (MMIS): Computerized system used for the processing, collecting, analysis and reporting of Information needed to support Medicaid and CHIP functions. The MMIS consists of all required subsystems as specified in the State Medicaid Manual.

Medical Advice Service: The twenty-four (24) hour emergency medical advice toll-free phone line operated by Triple-S through its Tele Mi Salud service.

Medical/Dental Record: The complete, comprehensive record of an Enrollee including, but not limited to, x-rays, laboratory tests, results, examinations and notes, accessible at the site of the Provider, that documents all health care services received by the Enrollee, as applicable, including inpatient, outpatient, ancillary, and emergency care, prepared in accordance with all applicable federal and Puerto Rico rules and regulations, and signed by the Provider rendering the services.

Medical Necessity or Medically Necessary: refers to those services that relate to the prevention, diagnosis, and treatment of health impairments, or to the ability to

achieve age-appropriate growth and development and the ability to attain, maintain, or regain functional capacity, and are:

a. Appropriate and consistent with the diagnosis of the treating Provider and

the omission of which could adversely affect the eligible enrollee’s medical condition;

b. Compatible with the standards of acceptable medical practice in the

community;

c. Provided in a safe, appropriate, and cost-effective setting given the nature of the diagnosis and the severity of the symptoms;

d. Not provided solely for the convenience of the enrollee or the convenience of

the Provider or hospital; and

e. Not primarily custodial care (for example, foster care).

In order for a service to be dentally necessary, there must be no other effective and more conservative or substantially less costly treatment, service or setting available. This definition shall not be interpreted or used to supersede any dental diagnosis done by the licensed dentist.

Medicare: The federal program of medical assistance for persons over age 65 and certain disabled persons under Title XVIII of the Social Security Act.

Medicare Part C: The part of the Medicare program that permits Medicare recipients to select coverage among various private insurance plans.

Medicare Platino: A program administered by ASES for Dual Eligible Beneficiaries, in which managed care organizations or other insurers under contract with ASES function as Part C plans to provide services covered by Medicare, and also to provide a “wraparound” benefit of Covered Services and Benefits under Mi Salud.

Mi Salud Contract: Means the contract between Triple S, Inc. and ASES for the services covered under the Puerto Rico Government Health Plan, known as the Mi Salud Program. Mi Salud (or “the Mi Salud Program”): The government health services program (formerly referred to as “La Reforma”) offered by the Government of Puerto Rico, and administered by ASES, which serves a mixed population of Medicaid Eligible, CHIP Eligible, and Other Eligible Persons, and emphasizes integrated delivery of physical and behavioral health services. It also means the physical health component of the Mi Salud Program offered to Eligible Persons in the Service Regions covered by Mi Salud Contract, and with respect to which Triple-S shall provide Administrative Services under Mi Salud Contract.

Mi Salud Policies and Procedures: Shall have the meaning ascribed to such term in Section 4.7.3 of Mi Salud Contract.

National Provider Identifier: The unique identifying number system for Providers created by the Centers for Medicare & Medicaid Services (CMS), through the National Plan and Provider Enumeration System.

Network: The entire group of Providers under currently valid Mi Salud contracts with Triple-S.

Network Provider: A Provider that has a contract with Triple-S under the Mi Salud Program.

Notice of Disposition: The notice in which Triple-S explains in writing to the Enrollee and the Provider of the results and date of resolution of a Complaint, Grievance, or Appeal.

Office of the Health Advocate: An office of the Government of Puerto Rico created by Law 11 of April 11, 2001, as amended, which is tasked with protecting the patient rights and protections contained in the Patient’s Bill of Rights Act.

Office of the Women’s Advocate: An office of the Government of Puerto Rico which is tasked, among other responsibilities, with protecting victims of domestic violence.

Other Eligible Person: A person eligible to enroll in the Mi Salud Program under Section 1.3.1.3 of Mi Salud Contract, who is not Medicaid- or CHIP Eligible; this group is comprised of the Commonwealth Population and certain public employees and pensioners.

Out-of-Network Provider: A Provider that does not have a contract with Triple-S under Mi Salud.

Patient’s Bill of Rights Act: Law 194 of August 25, 2000, as amended, a law of the Government of Puerto Rico relating to patient rights and protection.

Participating Dentist: For purposes of this Contract means the health care provider contracted by TSS which accepts the terms and conditions established herein as prescribed by ASES.

Potential Enrollee: A person who has been Certified by the Puerto Rico Medicaid Program as eligible to enroll in Mi Salud (whether on the basis of Medicaid eligibility, CHIP eligibility, or eligibility as a member of the Commonwealth Population), but who was not enrolled in the Mi Salud Plan prior to July 1, 2011.

Prompt Payment: timely payment of claims as prescribed on Section 16.10 of Mi Salud Contract.

Preferential Turns: The policy of requiring Network Providers to give priority in treating Enrollees from the island municipalities of Vieques and Culebra, so that they may be seen by a Provider within a reasonable time after arriving in the

Provider’s office. This priority treatment is necessary because of the remote locations of these municipalities, and the greater travel time required for their residents to seek medical attention.

Preventive Services: Health care services provided by a physician, dentist or other Health Care Professional within the scope of his or her practice under Puerto Rico law to prevent disease, disability, or other health conditions; and to promote physical and mental health and efficiency.

Primary Care: All health care services, including periodic examinations, preventive health care services and counseling, immunizations, diagnosis and treatment of illness or injury, coordination of overall medical or dental care, record maintenance, and initiation of Referrals to specialty Providers described in Mi Salud Contract and for maintaining continuity of patient care.

Provider: Any dentists, physician, hospital, facility, or other Health Care Professional who is licensed or otherwise authorized to provide health care services in the jurisdiction in which they are furnished.

Provider Contract: The written contract as approved by ASES between Triple-S and a Participating Dentist, setting forth the terms and conditions under which the Provider will provide Covered Services to Enrollees.

Puerto Rico Medicaid Program: The subdivision of the Puerto Rico Health Department that conducts eligibility determinations for Medicaid, CHIP, and the Commonwealth Population.

Referral: A request by a PCP or other Provider in the PMG for an Enrollee to be evaluated.

Service Authorization Request: An Enrollee’s request for the provision of a Covered Service.

Service Region: A geographic area comprised of those municipalities where Triple-S is responsible for providing services under the Mi Salud Program which for purposes of Mi Salud Contract shall include the Virtual Region and the following geographic service regions: Metro North, North, San Juan, Northeast and West regions.

Tele Mi Salud: The Enrollee support Call Center that the Triple-S shall operate as described containing two components: the Information Service and the Medical Advice Service.

Terminal Condition: A condition caused by injury, illness, or disease, from which, to a reasonable degree of certainty, will lead to the patient’s death in a period of, at most, six (6) months.

Third Party: Any person, institution, corporation, insurance company, public, private or governmental entity who is or may be liable in contract, tort, or otherwise

by law or equity to pay all or part of the medical cost of injury, disease or disability of an Enrollee.

Third Party Liability: Legal responsibility of any Third Party to pay for health care services.

Underlying Agreement or Mi Salud Agreement: shall mean the Agreement executed between Triple-S Salud, Inc. and ASES for the Administration of health services to the Mi Salud Enrollees.

Urgency: Shall have the meaning ascribed to such term in the Patient’s Bill of Rights Act.

Utilization: The rate patterns of service usage or types of service occurring within a specified time.

Virtual Region: The Service Region for the Mi Salud Program that is comprised of children who are in the custody of ADFAN, as well as certain survivors of domestic violence referred by the Office of the Women’s Advocate, who enroll in the Mi Salud Program. The Virtual Region encompasses services for these Enrollees throughout Puerto Rico.

Week: The traditional seven-day week, Sunday through Saturday.

ARTICLE II INTRODUCTION

2.1 The terms and conditions described in this Amendment will prevail over those

contained in the contract between TSS and the Participating Dentist, as long as services are provided to the Enrollees under the Mi Salud Program established by TSS. Furthermore, in the event of incompatibility, the terms and conditions described in the contract between TSS and ASES for the Mi Salud program will prevail over those contained in the contract attached to this Circular Letter. For ready reference, the Triple-S-ASES Mi Salud agreement is available through the Triple-S website www.ssspr.com.

2.2 Each one of the parties is committed to access to care policies established by ASES,

as well as to rendering health services in the most efficient manner possible, following accepted standards of dental practice standards within a Coordinated Care Model, managed through the integration of physical and mental health with a continued emphasis on the prevention, quality and access to clinical services.

2.3 The Participating Dentist acknowledges that the terms and conditions of the Mi

Salud Program are subject to subsequent changes in legal requirements, as

provided by law, regulation or as otherwise required by the Center for Medicare and Medicaid Services (CMS) and/or by ASES.

2.4 The scope and applicability of the terms and conditions of this Amendment may vary,

depending on provider type. Language particular to any given type of provider has been included herein as an Attachment addressed specifically towards the particular type of provider. Notwithstanding, the Participating Dentist acknowledges its responsibility to guarantee full compliance with all applicable terms and conditions of the Plan Mi Salud, and accepts it obligation to cure any deficiencies that ASES or TSS may identify during the course of this Amendment.

2.5 The Participating Dentist acknowledges that the assignment or transfer of the

obligations arising from this Amendment to a third party is expressly prohibited. However, TSS may assign this Agreement to a parent, affiliate or subsidiary company, should it be deemed necessary or convenient by TSS. In such event, it will timely notify the Participating Dentist who can terminate this contract under the terms prescribed in Article 11.1, Section 1, B., 1, b, and 11.1 C of Regulation 7617 of the Office of the Health Advocate of the Government of Puerto Rico. Services during the periods prescribed in the aforementioned Regulation will be paid at the fee established in the reimbursement schedule.

ARTICLE III GENERAL TERMS

3.1 The Participating Dentist agrees to verify the eligibility of beneficiaries prior to

providing his/her services, and will not, under any circumstance, require any additional payment from its patients for services rendered under Amendment, other than those allowed as copayments or deductibles, if applicable.

3.2 The Participating Dentist agrees to observe and to comply with applicable provider protocols and/or guidelines set forth by TSS in its Provider Manual as required and approved by ASES. ,

3.3 The Participating Dentist agrees to observe and to comply with any and all

applicable Federal and State laws and regulations, rules and applicable procedures approved and instituted by ASES, as well as any terms, clauses and conditions that may be required from time to time by the Center for Medicare and Medicaid Services (CMS).

3.4 The Participating Dentist will not discriminate against an Enrollee because of their health status or need for health care services, age, sex, race, religion, color, nationality, political or social condition, and will not use any policy or practice that has the effect of discriminating on those basis, no matter the area of operation of the Plan, including but not limited to providing care during different days or hours, hospitalization and patient care, room assignment and selection of service providers in the hospital at the same level, scope, and quality, according to the standard of good dental practice.

3.5 The Participating Dentist will not discriminate against high-risk or high-cost

Enrollees, or operate on a different schedule for Mi Salud enrollees than for other patients. Also, the participating hospital or emergency room may not refuse to receive an ambulance transporting a Plan enrollee, or refer it to another facility, with the purpose of reserving its emergency facilities for patients with private insurance. ASES may impose upon the Participating Dentist penalties for non-compliance, in accordance with its applicable rules and regulations.

3.6 Any unreasonable denial, delay or rationing of covered services to Mi Salud

enrollees is expressly prohibited. The Participating Dentist will be accountable for ensuring compliance with this provision. Violations will constitute a breach of this Agreement, and shall be subject to penalties and/or sanctions payable to ASES, in accordance with Article XI of this Amendment.

3.7 The Participating Dentist agrees to cooperate with the activities for the continued

improvement of the quality program, thus allowing or facilitating the compilation of information for the development of investigations or research benefitting the members of the Plan in compliance with HIPAA and other applicable privacy laws.

3.8. The Participating Dentist agrees to not distribute medicines or drugs with the sole

purpose of inducing the patient, not use the pharmacies that have a signed contract with the Pharmacy Benefits Manager (PBM), whom in turn has a contract with ASES. The physician will provide a drug prescription to the enrollee, so that he/she may choose a participating pharmacy. Non-compliance by the Participating Dentist may result in the imposition of sanctions or fines, payable to ASES.

3.9 The Participating Dentist assures that it has no financial interest, direct or indirect, with or in relation to the owners, subsidiaries, or affiliates of a health facility (as defined by the Health Facilities Act, Act No. 101 of June 26, 1965, as amended) which provides services to the beneficiaries of Mi Salud or to TSS and its affiliates.

3.10 In the event of termination of the contractual relationship between TSS and ASES, the parties will continue to engage their payment obligations to the Participating Dentist until the final bill presented at the expiration date. TSS and Participating Dentist will be required to continue cooperating, sharing and transferring the data about the Enrollee to the new Administrator or Insurer for a minimum period of ninety (90) days.

3.11 The Participating Dentist shall be free to engage in a full range of dental counseling,

in accordance with the enrollee’s condition. TSS will not interfere, prohibit, or restrict any health care professional from advising or advocating, within their scope of practice, on behalf of an enrollee, regarding health status, medical care, or treatment or non-treatment options, or any grievance system or utilization management process, or individual authorization process to obtain medically necessary health care services. The Participating Dentist shall not discriminate based on the recipient's health status or need for health care services.

3.12 The Participating Dentist must give Preferential Turns to Enrollees from the islands of Vieques and Culebra, in order to comply with applicable law and regulation.

3.13 The Participating Dentist who wishes to participate the Medicare Platino Program, will be required to participate in the Mi Salud program.

3.14 The Participating Dentist may not employ or subcontract with individuals on the

Puerto Rico or Federal Exclusions list, or with any entity that could be excluded from the Medicaid program under 42 CFR 1001.1001 (ownership or control in sanctioned entities) and 1001.1051 (entities owned or controlled by a sanctioned person).

3.15 The Participating Dentist agrees to comply with its obligations under Law No. 160 of

November 17, 2001, as amended, to inform and provide written information to adult enrollees regarding their right to Advance Directives. TSS shall provide a model document regarding the Advance Directives and inform the Participating Dentist of any changes in local law, no later than ninety (90) days after such changes are set to take effect so the dentist will keep its enrollees actively informed.

3.16 The Participating Dentist understands and accepts to comply that enrollee is

guaranteed the right to be treated with respect and with due consideration for his or her dignity and privacy:

Enrollee is guaranteed the right to receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee's condition and ability to understand.

Enrollee is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment.

Enrollee is guaranteed the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.

Enrollee is guaranteed the right to request and receive a copy of his or her

medical records, and to request that they be amended or corrected, as

specified in 45 CFR Part 164.

3.17 TSS provider selection policies and procedures cannot discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment.

ARTICLE IV COMPLIANCE EVALUATION PROGRAM

4.1 The Participating Dentist and TSS agree that all dental records and all personal

information of the subscriber of the plan will be confidential, to the extent required by state and federal laws governing the confidentiality of medical records. Independently of these confidentiality privileges, by subscribing to the Mi Salud Plan, the beneficiary of Mi Salud, authorizes the Federal Government, CMS, the Office of Inspector General, the Department of Health and its office for the Puerto Rico Medicaid Program, ASES, the Office of the Comptroller of Puerto Rico, the Comptroller General of the United States, ASSMCA, the Office of the Insurance

Commissioner of Puerto Rico, the Department of Family and its ADFAN Program, the Office of the Women’s Advocate and its SDV Project, the Office of the Health Advocate, TSS and their representatives to inspect and copy its medical records with the purpose of conducting audits and assessments to determine the quality, adequacy, timeliness and cost of services provided under the plan. Notwithstanding any possible existing law, regulation or norm that may require that medical records be kept for a longer period, for the purpose of this contract, the medical records shall be kept and made available for inspection for a period of six (6) years from the date of the termination of this Amendment, unless:

a. ASES determines that there is a special need to retain a medical

record or a particular group of medical records for a reasonable period of additional time notifying TSS at least thirty (30) days prior to the normal date when the files were supposed to be disposed of;

b. There has been a cancellation issue, fraud or breach by TSS, in which

case the files will have to be available for up to six (6) years as of the date when the matter or issue is resolved;

c. ASES determines that there is a reasonable possibility that fraud has

been committed, in which case the file can be reopened at any given moment; or

d. There has been an audit intervention by CMS, the Office of the

Comptroller of Puerto Rico, the Comptroller General of the United States, or by ASES, in which case the retention of the medical file will be extended until the end of the audit and the publication of the final report concerning the audit.

4.2 Dentist agrees that TSS, or any state or federal regulatory agency, as required by law, shall have reasonable access and an opportunity to examine Dentist’s financial and administrative records pertinent to an audit related to the health care services provided to MI Salud Program insured’s. Such audits will be conducted during normal business hours, on at least fifteen calendar days advance notice, or such shorter notice as may be imposed on TSS by a federal or state regulatory agency or accreditation organization. The financial books or records shall be examined when suitable evidence or a written complaint related to illegal activities, “balance billing”, bribes, kickbacks, misappropriation, waste, abuse or fraud regarding financial matters, related to services provided under MI Salud Program, has been detected, filed or notified to TSS and/or any regulatory agency, or a finding has been identified during a first audit. TSS shall notify immediately ASES regarding such conduct or written complaint against the provider, once they have been confirmed. Before requesting the financial books, it shall be determined by both parties if there is a more efficient, practical, or economical method of obtaining the necessary information. If there is such a method or other source (e.g., the provider is able to furnish substantiation for the cost of the services or is able to clear the inconsistencies), the needed information shall be sought by that means before seeking to gain access to the provider’s financial books. If there is no alternate method or source, the access to request to those books will be limited to

the pertinent item(s) in question. It shall not make any unnecessarily burdensome or overly intrusive demands on a provider. The financial books or records shall be examined when suitable evidence or a written complaint related to illegal activities, “balance billing”, bribes, kickbacks, misappropriation, waste, abuse or fraud regarding financial matters, related to services provided under MI Salud Program, has been detected, filed or notified to TSS and/or any regulatory agency, or a finding has been identified during a first audit. TSS shall notify immediately ASES regarding such illegal activities suitable evidence or written complaint against the provider, once they have been confirmed.

4.3 In the case of an audit, the Participating Dentist will allow any invoice, payment form

or clinical record of the Enrollee, to be completely audited and copied without alteration, after receiving notice within a reasonable amount of time which shall not be less than fifteen (15) working days. The schedule for the audit will be coordinated with the dentist so as to cause minimal interruption. The audit results will be reported to the provider.

4.4 All the provisions of the TRIPLE-S audit protocol established under the Underlying

Agreement, or arising there under, are expressly incorporated herein, except those pertaining to the application of projections or projections formulae. In all audits arising under the Mi Salud Program, TSS and the Participating Dentist agree not to use projection formulae and to audit the universe of the audited criteria instead when it is considered necessary to achieve the audit objectives.

4.5 The Participating Dentist agrees to submit to TRIPLE-S all of the required document

for Credentialing and Re-Credentialing process.

ARTICLEV PAYMENT OF CLAIMS

5.1 The Participating Dentist recognizes that TSS has executed an Administrative

Services Only Agreement with ASES to provide administrative services to the Mi Salud Enrollees. Therefore, the Participating Dentist acknowledges that Triple-S, as a Third Party Administrator, will act as an intermediary payment agent, among other administrative duties, on behalf of ASES. Triple-S will depend on ASES timely funding in order to issue payment to providers for services rendered. ASES shall timely pay TSS, otherwise the dentist can terminate this contract immediately accordingly to the applicable laws and regulations.

5.2 The Participating Dentist hereby acknowledges and accepts the service fees

established by ASES, as full payment for the services provided under this agreement, apart from applicable deductibles, co-payments and/or co-insurance, if any. The provider agrees not to seek, under any circumstance, additional payments

from Mi Salud Enrollees. TSS shall not pay any Claim for a service already provided or a service previously paid under the Mi Salud program. Non-compliance with the provisions in this section may be subject to penalties and/or sanctions, at the discretion of ASES. Provider further acknowledges that Mi Salud rates shall be subject to adjustments, in the event that ASES directs TSS to make

such adjustments in order to reflect budgetary changes to the Medical Assistance Program.

5.3 CLEAN CLAIMS PAYMENTS: A Clean Claim, as defined in 42 CFR 447.45, is a Claim received by the TSS for adjudication, which can be processed without obtaining additional information from the Participating Dentist of the service or from a Third Party, as provided in Section 22.4.5.1 of Mi Salud Contract which states that when TSS is aware of health or casualty insurance coverage before paying for a Covered Service, TSS shall avoid payment by promptly (within fifteen (15) Business Days of receipt) rejecting the Provider’s claim and directing that the Claim be submitted first to the appropriate Third Party. It includes a Claim with errors originating in the TSS’s claims system. It does not include a Claim from a Participating Provider who is under investigation for Fraud or Abuse, or a Claim under review for Medical Necessity.

Provider Contracts shall provide that ninety-five percent (95%) of all Clean Claims must be paid by the TSS not later than thirty (30) Calendar Days from the date of receipt of the Claim (including Claims billed by paper and electronically), and one hundred percent (100%) of all Clean Claims must be paid by the TSS not later than fifty (50) Calendar Days from the date of receipt of the Claim.

Any Clean Claim not paid within thirty (30) Calendar Days shall bear interest in favor of the Participating Dentist on the total unpaid amount of such Claim, according to the prevailing legal interest rate fixed by the Puerto Rico Commissioner of Financial Institutions. Such interest shall be considered payable on the day following the terms of this Section 16.10 of Mi Salud Contract, and interest shall be paid together with the Claim. If the delay in payment to a Participating Provider is the result of the actions or omissions by TSS, TSS shall be responsible (i) for payment of any interest due to the Participating Dentist under this Section and as prescribed by ASES.. If the delay in payment to a Participating Provider is the result of ASES’s failure to make timely and complete Claims Payments to TSS when due, ASES (and not TSS) shall be responsible to (i) pay any such interest due to the Participating Dentist. Nothing in this contract prohibits the dentist to sue ASES to recover and/or collect any outstanding debt after notifying ASES of said debt and intention to sue.

An Unclean Claim is any Claim that falls outside the definition of Clean Claim in Section 16.10.2.1 of Mi Salud Contract. TSS shall include the following provisions in its Participating Provider Contracts for timely resolution of Unclean Claims.

Ninety percent (90%) of Unclean Claims must be resolved and processed with payment by the TSS, if applicable, not later than thirty (30) Calendar Days from the date of initial receipt of the Claim. This includes Claims billed on paper or electronically.

Of the remaining ten percent (10%) of total Unclean Claims that may remain outstanding after thirty (30) Calendar Days.

Nine percent (9%) of the Unclean Claims must be resolved and processed with payment by TSS, if applicable, not later than ninety (90) Calendar Days from the

date of initial receipt (including Claims billed on paper and those billed electronically); and

One percent (1%) of the Unclean Claims must be resolved and processed with payment by the TSS, if applicable, not later than one year (12 months) from the date of initial receipt of the Claim (including Claims billed on paper and those billed electronically).

The TSS shall submit an Unclean Claims Report each fifteenth (15th) and (30th) day of each calendar month in a format to be provided by ASES. The TSS shall continue to submit an Unclean Claims Report until all such Claims have been resolved or through the Runoff Period, whichever is longer.

5.4 ASES has established dental rates and coverage to be administered by Triple-S. Triple-S establishes its dental network using the approved rates. Such rates shall be subject to adjustments, in the event ASES directs TSS to make such adjustments in order to reflect budgetary changes in the Mi Salud Program. These shall be notified in advance to the Participating Dentist.

5.5 The Participating Dentist will make every effort to identify and notify TSS of any third-

party liability sources. Mi Salud will not cover any services already covered by the Medicare Program.

5.6 Participating Dentist will sign a release giving ASES access to its Medicare billing

data for Mi Salud enrollees who are dual-eligible beneficiaries, provided that such access is authorized by CMS, and subject to compliance with all HIPAA requirements.

5.7 TSS and Participating Dentist acknowledge and agree to follow the accepted

American Dental Association Current Dental Terminology coding requirements.

5.8 The Participating Dentist acknowledges that it is subject to any proceeding as prescribed in Section 10.5.4 of the Mi Salud Contract seeking reimbursement of monies due to any outstanding debts that he or she may have with the Government of Puerto Rico. In all such proceeding, any reimbursement, assessment or penalty imposed shall be subject to the constitutional protections warranted by the Constitution of the United States of America, the Commonwealth of Puerto Rico or any applicable law or regulation.

ARTICLE VI CONFIDENTIALITY

6.1 The Participating Dentist acknowledges that ASES is the sole and exclusive owner

of all the information related to Mi Salud, including but not limited to the eligibility and subscription data of the beneficiaries, health information of the beneficiaries, utilization and costs of services provided, health information, etc. The Participating Dentist may not transfer, assign or sell this information to third parties, or use it for commercial purposes or for their private business. To incur in said practice constitutes a violation of HIPAA and the property rights of ASES, and may result in penalties, fines and the termination of the Participating Dentist Contract. Any fines imposed on the Participating Dentist for violation of this clause shall be payable to ASES, in accordance with Article XII of this Amendment.

6.2 The Participating Dentist acknowledges that the unauthorized sharing or transfer of

ASES data by the Participating Dentist is expressly prohibited, and subject to penalties and/or sanctions, at ASES’s discretion.

ARTICLE VII REPORTING REQUIREMENTS

7.1 The Participating Dentist agrees to comply at all times with the reporting

requirements that may be established by TSS, as mandated and provided by ASES, in this Amendment. All reports submitted to TSS must include the Participating Dentist’s NPI number.

7.2 The Participating Dentist agrees to comply with the plan for the detection and

prevention of fraud, waste and abuse established by CMS, ASES and TSS. 7.3 The Participating Dentist will notify TSS in writing, whether it has been, or whose

affiliated subsidiary companies, or any of its shareholders, partners, officers, principals, managing employees, subsidiaries, parent companies, officers, directors, board members, or ruling bodies have been, under investigation for, accused of, convicted of, or sentenced to imprisonment, in Puerto Rico, the United States of America, or any other jurisdiction, for any crime involving corruption, fraud, embezzlement, or unlawful appropriation of public funds, pursuant to Act 458, as amended, and Act 84 of 2002.

7.4 As provided in 42 CFR 455.106(c), the Participating Dentist will notify TSS if any

person who has an ownership or control interest in the Participating Dentist, or is an agent or managing employee of the Participating Dentist, has been convicted of a criminal offense related to the person’s involvement in any program established under Medicare, Medicaid, or the Title XX services programs. The Participating Dentist shall disclose to TSS the identity of any person who has been convicted of a criminal offense related to the Medicare, Medicaid, or Title XX services programs, or has otherwise been excluded from participating in these programs.

7.5 The Participating Dentist agrees to return any public funds received for services rendered under this Amendment while falling within the prohibitions set forth in this article.

7.6 Violations to any provision in this Article VIII are expressly prohibited, and subject to

penalties and/or sanctions, including termination of the Contract, at ASES’s discretion.

ARTICLE VIII

ADDITIONAL PROGRAMS AND ACTIVITIES 8.1 The Participating Dentist agrees to cooperate, comply with and to put into practice

any and all health programs and/or activities required by ASES and implemented by TSS, including quality improvement, prevention, utilization management and clinical services programs.

8.2 Participating Provider shall comply with the Participating Dentist guidelines and

participate of Mi Salud Provider Training and Provider Education Programs or related meetings and activities regarding Mi Salud Program.

8.3 Participating Provider further agrees to participate in the TSS Cultural Competency

Plan, as required by ASES. Requirements for this program will be notified to the provider by TSS and upon notification, will be made part of hereof.

ARTICLE IX COLLECTION FOR COVERED SERVICES

9.1 ASES will be responsible for payments owed to the Participating Dentist, after

validation and confirmed as ready-to –pay by TSS, for covered services rendered, starting on November 1

st, 2011 or after the effective date of this Amendment,

whatever occurs first. TSS, as administrator of Mi Salud, will be responsible for issuing payment to providers from an account which shall be funded by ASES.

9.2 The Participating Dentist will only be entitled to payment for those services covered

under Mi Salud Plan and by the enrollee for those uncovered services by Mi Salud program. Dentists will only charge the enrollees for any deductibles, copayments or co-insurance established by TSS for Mi Salud Plan. Undue debt collections and balance billing to the insured are expressly forbidden under any circumstance.

The Participating Dentist must comply with the collection of co-payments from the

enrollee, whenever applicable. Failure by the Participating Dentist to collect these amounts shall constitute a breach of this Circular Letter.

9.3 TSS can cancel or refuse to renew the Participating Dentist’s contract without prior

notice, and at any given moment, in any case where undue debt collection or balance billing is made, either to TSS on behalf of ASES or ASES or to the Enrollee.

9.4 In cases where the Enrollee is a dual-eligible beneficiary, the Participating Dentist

must guarantee it will not bill both, Mi Salud and the Medicare Program, for the same service.

ARTICLE X

PENALTY CLAUSE 10.1 The Participating Dentist must comply with all the requirements aforementioned. 10.2 The Participating Dentist acknowledges and agrees that he/she will be subject to the

instances where ASES takes actions or orders immediate compliance with any legal or regulatory provision that is being breached by the participating dentist. The breach of any of the clauses aforementioned or the regulations and legal dispositions required by ASES could lead to administrative fines payable to ASES as established by ASES Mi Salud contract.,.

ARTICLE XI MARKETING

11.1 Any marketing materials developed and distributed by the Participating Dentist must

be submitted to TSS prior to publication. TSS will refer the materials to ASES for approval before authorizing their use.

ARTICLE XII TERMS

12.1 This Amendment will be effective upon receipt by the Participating Dentist, and will

remain in full force and effect until June 30, 2013, subject to its early termination as follows: (i) it shall immediately terminate, in the event that the Underlying Agreement between TSS and ASES or of the main agreement between Participating Provider and TSS is terminated with cause as established in section 10.4.1.1 of Mi Salud contract, or (ii) thirty days after the Participating Dentist notifies Triple-S in writing of its decision to opt out of the Mi Salud plan. Any event of terminations shall be subject to the transition care provisions of Act 194 of August 25, 2000, also known as “Carta de Derechos y Responsabilidades del Paciente”. Provided, however that any determination by the Participating Dentist to terminate his/her participation in the Mi Salud Program will not terminate his/her participation in Triple-S’ other commercial lines of business, except as provided hereinbefore with respect to the Medicare Platino Program.

12.2 Notwithstanding the above, according with 42 CFR 438.10(f)(5), TSS may terminate

this Amendment upon a written notice if:

a. Participating Provider fails to comply with its obligations under this Amendment

b. Changes in Federal or State law that require such action

c. Deficiency of funds by ASES

12.3 Notice of provider termination Triple-S must make a good faith effort to give written notice of termination of a contracted provider, within (fifteen) 15 days after receipt or issuance of the termination notice, to each Enrollee who received his or her care from, or was seen on a regular basis by, the terminated provider. If TSS declines to include individual or groups of providers in its network, it must give the affected providers written notice of the reason for its decision according with 42 CFR 438.12 (a).

12. 4 In the event of termination of this Amendment or the Participating Dentist Agreement, or the Agreement between ASES and Triple-S, during the course of treatment of an enrollee, the provider agrees to provide continuous care and coordinate with TSS the necessary steps for proper enrollee transition, in accordance with the Puerto Rico Patient’s Bill of Rights.

This Amendment contains the terms of understanding between the Participating Dentist and TSS with regard to the Mi Salud program. Its terms reflect terms incorporated from the Underlying Agreement between TSS and ASES, but which also pertain to CMS’ requirements. Hence, the Participating Dentist acknowledges that this amendment may be modified by TSS as required by ASES or CMS. Upon any such modification, TSS will promptly advise the Participating Dentist. Any terms and conditions of the Underlying Participating Dentist contract between the Participating Dentist and TSS that are not modified by this Circular Letter or its attachment, shall remain in full force and effect, but the dentist can terminate his participation in the Mi Salud Program in accordance with Article 11 of the Regulation 7617 of the Office of the Health Advocate.

ATTACHMENT TO AMENDMENT TO THE PARTICIPATING DENTISTAGREEMENT FOR RENDERING DENTAL SERVICES UNDER MI SALUD PROGRAM

On November 1, 2011, Triple S Salud Inc. (Triple S) and the Puerto Rico health Insurance Administration (ASES, by its Spanish acronym, entered into an agreement to provide services under the Mi Salud Program for the following regions: Norte, Metro-Norte, San Juan, Oeste and Noreste.

1. The dental services to be provided under MI Salud Program will be provided

and contracted in accordance with the any willing provider rule. The Dentist is

not subject to be contracted under the model known as “Preferred Provider

Network” (PPN) for the Primary Medical Groups (PMGs). All licensed dentists

in Puerto Rico are to be contracted without limitations of area within Puerto

Rico. Any dentist that is willing to become a provider and complies with ASES

and Triple-S’ credentialing requirements will be contracted.

2. Payment for the services rendered by the dentist is based on a “fee-for-

service” basis. Dentist shall not be subject to a capitated payment agreement.

Dentists are precluded from entering into any capitated agreement with any

Primary Medical Group1.

3. The beneficiaries of the MI Salud Program can access any dentist within the

dental network of providers of Triple-S, and shall not be required to obtain a

referral from the primary care physician.

4. For purposes of Dental Services Provider Contracts, the term “Clean Claim”

shall mean a claim received by Triple-S’ for adjudication, in a American Dental

Association (ADA) accepted format in compliance with standard ADA coding

guidelines and which can be processed without obtaining additional

information from the Provider of the service or from a Third Party. It does not

1Primary Medical Group: Known by its initials as PMG. A PMG is a group of physicians organized as a profit or nonprofit

corporation, professional corporation, partnership or association, engaged in providing coordinated care services. The PMG

has entered into a contract with MCS HMO to provide to enrollees its coordinated care services.

include a claim from a Provider who is under investigation for Fraud or Abuse,

or a claim under review for Medical Necessity, when applicable.

5. The Dentist shall comply with accepted Triple S billing and claim processing

procedures, based on ADA standards. Claims shall be submitted using the

current ADA 2006 form or an electronic transmission format which, fully

complies with the Codes and Transactions Standard (EDI Rule) established by

the Department of Health and Human Services of the United States in

accordance with the provisions of the Health Insurance Portability and

Accountability Act of 1996 (HIPAA).

6. The Dentist will submit the claims in a term that will not exceed 90 days from

the day the service was provided.