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DocuSign Envelope ID: 78CDD188-656B-44E9-9F46-9AFBF222884F <br />6. ADMINISTRATIVE FEE <br />a) Two times per year, HCA will invoice the Contractor for an Administrative Fee. This fee <br />offsets and will not exceed the costs for administering the MAC program for the State of <br />Washington. Administrative Fees charged to MAC contractors are used to provide the <br />state share of match required to operate the program. <br />b) The Contractor must submit payment of Administrative Fees within forty-five (45) <br />business days of the date on the Administrative Fee invoice. The Administrative Fee <br />must be paid with non-federal dollars. HCA will not process any A 19s until the <br />Administrative Fee is paid to HCA. <br />c) The Administrative Fee is an unallowable expense and the Contractor is prohibited from <br />including any portion of the Administrative Fee in its calculations for FFP reimbursement. <br />Contractor must mail Administrative Fee payment to the following address: <br />Health Care Authority <br />Financial Services/Accounting <br />PO Box 45500 <br />Olympia, Washington 98504-5500 <br />7. TIMELY FILING AND OVERPAYMENT REqUIREMENTS: <br />The Contractor must submit invoices for reimbursement to HCA for review and approval <br />within one hundred twenty (120) calendar days following the end of each Billing Quarter. <br />Upon approval, the Contractor must submit a signed A 19-1A invoice voucher within fifteen <br />(15) calendar days. <br />a) Invoices submitted after one hundred twenty (120) calendar days following the end of <br />the Billing Quarter may result in corrective action. <br />b) HCA will not offset negative balances against future A19s. The Contractor must <br />immediately remit a check to HCA for any funds requiring repayment. <br />c) HCA is not a recovery agent and any overpayments that are at or beyond the one <br />hundred eighty (180) calendar day mark will be turned over to the Office of Financial <br />Recovery (OFR). - <br />8 . CALCULATING THE FFP AND GENERATING AN INVOICE <br />a) The Contractor is responsible for ensuring all data (including all RMTS and financial <br />data) used to calculate the amount of FFP submitted to HCA for reimbursement is <br />accurate, based on actual expenses incurred during the period of performance, and <br />complies with all federal, state, HCA and CMS Regulations, the CAP, Manual and this <br />Agreement. The Contractor must certify the accuracy of all data used to calculate the <br />amount of FFP by an authorized representative signing the A-19. The Contractor must <br />use a System that is statistically valid and in compliance with all state, and federal laws <br />and Regulations whether through a third-party or other means as stated in the CAP to <br />calculate the amount of FFP and generate a claim. <br />i) The Contractor must submit invoices to HCA for FFP on a quarterly basis; <br />ii) All data used to calculate the FFP must be from the same period of service; <br />State of Washington <br />Health Care Authority <br />Page 34 of 42 HCA Contract No . K1407-1