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DoaiSign Envelope ID: 262ABA18-53544F41-9508-91313C8ACBA6D <br />4.1.2. Fifty percent (50%) is received from the Contractor's Local Matching Funds. <br />4.2. Source of funds for Administrative Claiming for appropriately documented Skilled <br />Professional Medical Personnel and appropriately documented Interpreter staff <br />Administrative Claiming are as follows: <br />4.2.1. Seventy-five percent (75%) of funds is received from the United States Department <br />of Health and Human Services under Medical Assistance Program CFDA 93.778; <br />and <br />4.2.2. Twenty-five percent (25%) is received from the Contractor's Local Matching Funds. <br />4.3. HCA will not issue reimbursement for any quarters where HCA receives credible evidence <br />or suspected evidence of a system failure that has the potential to impact the integrity of the <br />reimbursement request. This includes but is not limited to failures related to the time study, <br />MER calculation, claim calculation, or reconciliation. <br />4.3.1. HCA will pursue corrective action as needed, and will restore payment after any <br />issues related to the reimbursement request are resolved, and the requested <br />amount is accurate. <br />5. BILLING PROCEDURE <br />Contractor must submit accurate invoices to the HCA Contract Manager for all amounts to be paid <br />by HCA via e-mail to the HCA Contract Manager email address listed on the cover of this <br />Agreement. Include the HCA Contract number in the subject line of the email. <br />All invoices submitted must receive approval of the HCA Contract Manager or their designee prior <br />to payment. Approval will not be unreasonably withheld. <br />Contractor shall only submit invoices for Services or deliverables as permitted by this section of the <br />Contract. The Contractor shall not bill HCA for Services performed under this Contract, and HCA <br />shall not pay the Contractor, if the Contractor is entitled to payment or has been or will be paid by <br />any other source, including grants, for such Services or deliverables. <br />Contractor must submit properly itemized invoices to include the following information, as <br />applicable: <br />a. HCA Contract number K4649; <br />b. Contractor name, address, phone number; <br />c. Description of Services; <br />d. Date(s) of delivery; <br />e. Net invoice price for each item; <br />f. Applicable taxes; <br />Washington State Page 10 of 53 HCA IAA K4649 <br />Health Care Authority Revised 10/2020 <br />