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DocuSign Envelope ID: 4166FC64-6496-4305-B555-38A 17 4BDAA73 <br />6. TIMELY FILING AND OVERPAYMENT REQUIREMENTS <br />The Contractor must submit invoices for reimbursement to HCA for review and approval within one <br />hundred twenty (120) calendar days following the end of each Billing Quarter. Upon approval, the <br />Contractor must submit a signed A19-1A invoice voucher within thirty (30) calendar days. <br />a) Invoices submitted after one hundred twenty (120) calendar days following the end of the <br />Billing Quarter may result in corrective action. <br />b) HCA will not offset negative balances against future A19s. The contractor must immediately <br />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 hundred <br />eighty (180) calendar day mark will be turned over to the Office of Financial Recovery (OFR). <br />d) HCA will not seek reimbursement for any invoice received after the 23rd month of the two- <br />year federal filing deadline. <br />7. CALCULATING THE FFP AND GENERATING AN INVOICE <br />a) The Contractor is responsible for ensuring all data (including all RMTS and financial data) <br />used to calculate the amount of FFP submitted to HCA for reimbursement is accurate, based <br />on actual expenses incurred during the period of performance, and complies with all federal, <br />state, HCA and CMS Regulations, the CAP, Manual, and this Agreement. The Contractor <br />must certify the accuracy of all data used to calculate the amount of FFP by an authorized <br />representative signing the A-19. The Contractor must use a System that is statistically valid <br />and in compliance with all state, and federal laws and Regulations whether through a third- <br />party or other means as stated in the CAP to calculate the amount of FFP and generate a <br />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 />iii. All data used to calculate the FFP must be the actual cost/expenditure and not <br />approximated; <br />iv . The FFP is determined by calculating the total adjusted costs, multiplying these costs <br />by the adjusted RMTS results, and the applicable Medicaid Eligibility Rate (MER), <br />adding any direct charges, and then applying the appropriate FFP rate; <br />v. The invoice must be generated within one hundred twenty (120) business days of the <br />end of the quarter; and <br />vi. The invoice is generated based on following five components: <br />( 1 ) Cost pool construction; <br />(2) Calculating allowable Medicaid administrative time via the System or direct <br />charge method and documentation; <br />(3) Calculation and application of the pertinent MER; <br />Local Health Jurisdiction Page 51 of 59 <br />Washington State Health Care Authority <br />Medicaid Administrative Claiming <br />Contract # K3069