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such providers or facilities must agree to abide by the provisions of paragraphs 2.15.1, 2.15.2, 2.15.3, 2.15.4, and 2.15.5 of this subsection 2.15. 2.15.7 Provider acknowledges that willfully collecting or attempting to collect an amount from a Participant knowing that collection to be in violation of this Agreement constitutes a Class C felony under RCW 48.80.030(5). 2. Eligibility. Section 3.5 is deleted in its entirety and the following is substituted therefore: 3.5 Eligibility. FCHN shall require all Payors to provide timely information on a Participant's eligibility for Covered Services, including any limitations or conditions on services or benefits, upon request by Provider. FCHN shall require that during ordinary business hours, FCHN Payors shall assure reasonable access, through standard means of communication for the confirmation that services are Covered Services and a Participant is eligible under a Benefit Plan. FCHN shall require Payors to give Provider full access to the coverage and services terms of the applicable Benefit Plan for a Participant. 3. RESPONSIBILITIES OF FCHN. A new section is added to Section 3. 3.12 Pharmacy Claims. Each Payor that is a health carrier will authorize a limited dispensed amount of medication that allows time for the processing of a preauthorization request ("Emergency Fill") by the dispensing pharmacist where a Participant presents at a Payor's contracted pharmacy with an immediate therapeutic need for a prescribed medication that requires a prior authorization. Claim payment for an Emergency Fill will be approved by a Payor that is a health carrier when: (i) the dispensing pharmacy cannot reach the Payor's prior authorization department by phone as it is outside of that department's business hours; or (ii) the Payor is available to respond to phone calls from a dispensing pharmacy regarding Covered Services but the Payor cannot reach the prescriber for full consultation. Each Payor that is a health carrier must disclose if the provider or pharmacy has the right to make a prior authorization request. Provider must contact each Payor that is a health carrier to obtain such information. If the Payor requires the authorization number to be transmitted on a pharmaceutical claim, the Payor will provide the authorization number to the billing pharmacy. The authorization number will be communicated to the billing pharmacy after approval of a prior authorization request and upon receipt of a claim for that authorized medication. 4. Claims Submission and Payment. Section 4.1.4 is deleted in its entirety and the following is substituted therefor, and the following additional paragraph is added to Section 4.2, immediately following the end of subsection 4.2.4: 4.1.4 Overpayment and Underpayment Recoveries Adjustments to claims that have been paid or denied, where the claim submittal failed to include a particular item or service, or was otherwise in error, must be requested and accomplished as follows, and refunds of incorrect claims payments must be requested and accomplished as follows: a. Except as provided in paragraphs 4.1.4 b and 4.1.4 c, a Payor may request a refund from Provider for overpayment of a previously paid claim provided the request is received by the Provider within 24 months after the initial payment was made. Such a request must be in writing and specify why Provider owes the refund. Where a request for refund is contested by Provider, Payor may not request that the refund be paid any sooner than six (6) months from the date of Provider's receipt of the request. A Payor's request for refund related to coordination of benefits with another entity responsible for payment of a claim must be received in writing by the Provider within thirty (30) months after the date the payment was made. The request must specify why Provider owes the refund and include the name and mailing address of the entity that has primary responsibility for payment of the claim. Where a request for refund is contested by Provider, Payor may not request that the refund be paid any sooner than six (6) months from the date of Provider's receipt of the request. FCHN-PRO-042016 Sch C - WA