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3.5.6 If the Medical Group contracts with other health care providers or facilities who agree to provide Covered Services to Members with the expectation of receiving payment directly or indirectly from the Company, such providers or facilities must agree to abide by the above provisions 3.5.1, 3.5.2, 3.5.3, and 3.5.4 and 3.5.5. 3.6 TH[RD-PARTY PAYMENT — Members may be eligible for coverage from another payer including, but not limited to, other individual or group health plans, liability insurers, entities providing workers' compensation or occupational disease coverage, Medicare or other government programs. The parties will inform each other whenever a Member has coverage from such other payers. Medical Group will collect payment from third -party payers, using Medical Group's customary collection procedures, whenever such payers have primary responsibility to provide or pay for Covered Services in accordance with the Coordination of Benefits and third -party liability requirements of Members' Health Plans. If Company is required to pay a portion of Medical Group's charges for Covered Services not covered by other payers, Company will pay Medical Group only that amount which when added to the amounts paid or owed by the other payer and any Copayment, Deductible or Co -Insurance charges for which the Member is responsible, will not exceed the payment for such services under this Agreement. 3.7 DUPLICATE BILLING — Unless otherwise instructed by Company, Medical Group agrees to refrain from submitting more than one bill to Company for Covered Services furnished to Member pursuant to this Agreement. Medical Group will not, under any circumstances, including a delay in Company's processing of Medical Group's claims, bill Members for Covered Services while waiting for payment. 3.8 ADJUSTMENTS — Medical Group will refund to the Company all overpayment amounts Company has paid to Medical Group because of payment error, duplicate insurance, Workers' Compensation recovery or other third party liability recovery, among other reasons, up to the amount of the overpayment. Medical Group will refund such overpayment amounts provided that written notification that a refund is due is received within twenty-four (24) months of original payment of the claim (thirty (30) months in the case of claims involving Coordination of Benefits), except if recovery from a third party is the cause of the delay. In the case of recovery from a third party, the Company may request that Medical Group refund a payment or part of a payment at any time if: (a) a third party, including a government entity, is found legally responsible or liable for satisfaction of the claim as a consequence of liability imposed by law (e.g., tort liability); and (b) the Company is unable to recover directly from the third party because the third party has either already paid or will pay the Medical Group for the claim. Notwithstanding the foregoing, Medical Group may contest a refund request made by the Company. However, if Medical Group fails to contest the refund request, in writing, within thirty (30) days of receipt of written notification that a refund is due, Company shall conclude that Medical Group has accepted the Company's refund request and may deduct from future payments due to Medical Group the amount equal to the amount of the overpayment, among other remedies. Medical Group shall not request from Company any additional payment to satisfy a claim unless the request is (a) in a writing that specifies why Company owes the additional payment, and (b) made within twenty-four (24) months after the original date the claim was paid or denied (thirty (30) months in the case of claims involving Coordination of Benefits). None of the aforementioned time limitations apply to requests for refunds or additional payments involving fraud. All disputes and appeals of billing issues pursuant to Section 9 must be initiated within the aforementioned time limitations. 3.9 NON -COVERED SERVICES 3.9.1 Except as otherwise set forth in this Section 3.9, Medical Group may charge Member for Non -Covered Services under the Subscriber Agreement without Asuris MGA Agreement (Rev. 05/2017) A18816854AA Page 7 of 20