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c. A Payor may at any time request a refund from a Provider of payment previously made to <br />satisfy a claim if a third party, including a government entity, is found responsible for <br />satisfaction of the claim as a consequence of liability imposed by law and the Payor is unable <br />to recover directly from the third party because the third party has or will pay Provider for the <br />services covered by the claim. <br />Provider may contest a refund request described in paragraphs 4.1.4 a or 4.1.4 b in writing to <br />the Payor within thirty (30) days after receipt in accordance with Section 9, Dispute <br />Resolution, of this Agreement. If Provider fails to contest a request within this thirty (30) day <br />period, the request shall be deemed accepted by Provider as due and owing, and Provider <br />shall pay the refund. If Provider has not paid the refund within thirty (30) days after the <br />request is deemed accepted, the Payor may recover the amount through an offset to a future <br />claim. <br />e. Provider may request an additional payment from a Payor to satisfy a claim provided the <br />request is received by the Payor within twenty four (24) months from the date the claim was <br />denied or payment intended to satisfy the claim was made. Such a request must be in writing, <br />specify why Provider believes Payor owes the additional payment, and may not require that <br />the additional payment be made any sooner than six (6) months from the date of Payor's <br />receipt of the request. Any dispute arising out of such a request shall be handled in <br />accordance with Section 9, Dispute Resolution, of this Agreement. <br />A Provider's request for additional payment related to coordination of benefits with another <br />entity responsible for payment of a claim must be received in writing by the Payor within thirty <br />(30) months after the date the claim was denied or payment intended to satisfy the claim was <br />made. The request must specify why the Payor owes the refund and include the name and <br />mailing address of the entity that has disclaimed responsibility for payment of the claim. The <br />request for additional payment may not request that the additional payment be made any <br />sooner than six (6) months after receipt of the request. <br />g. As used in this Section, "refund" means the return, either directly or through offset to a future <br />claim, of some or all of a payment already received by Provider. <br />h. This Section does not apply to claims for services provided through dental -only Payors or to <br />claims for services rendered pursuant to the Medicare or Medicaid programs. <br />4.2.4 FCHN shall require that any Payor failing to pay claims within the above stated standards and <br />any other standard established by applicable state law or regulation shall pay interest on undenied and <br />unpaid clean claims more than sixty-one days old until the Payor meets these defined standards. <br />Interest shall be assessed at the rate of one percent per month, and shall be calculated monthly as <br />simple interest prorated for any portion of a month. The Payor shall add the interest payable to the <br />amount of the unpaid claim without the necessity of Provider submitting an additional claim. Any <br />interest paid under this section shall not be applied by the Payor to a Participant's Deductible, Co- <br />payment, Coinsurance, or any similar obligation of the Participant. <br />5. Record Retention. Section 5.2 is deleted in its entirety and the following is substituted therefore: <br />5.2 Record Retention <br />Both parties shall retain all records relating to this Agreement for a minimum of ten (10) years. <br />6. Notice to Participants. Section 8.4 is deleted in its entirety and the following is substituted therefor: <br />8.4 Notice to Participants. If this Agreement is terminated, FCHN shall require Payors to make a <br />good faith effort to provide written notice of the termination to all Participants who are patients of Facility <br />or Facility based providers and who are seen on a regular basis by a specialist, by a provider for whom they <br />have a standing referral, or by a primary care provider within thirty (30) days of receipt or issuance of the <br />FCHN-PRO-042016 <br />Sch C - WA <br />