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DocuSign Envelope ID: 262ABAl8-5354-4F41-9506-9613C8ACBA6D 3. Billing and Claiming The Contractor must submit invoices for reimbursement to HCA for review and approval within one hundred twenty (120) calendar days following the end of each Billing Quarter. Upon approval, the Contractor must submit a signed A19 -1A invoice voucher within thirty (30) calendar days. 3.1. Invoices submitted after one hundred twenty (120) calendar days following the end of the Billing Quarter may result in corrective action. 3.2. HCA will not offset negative balances against future Al 9s. The Contractor must immediately remit a check to HCA for any funds requiring repayment. 3.3. HCA is not a recovery agent and any overpayments that are at or beyond the one hundred eighty (180) calendar day mark will be turned over to the Office of Financial Recovery (OFR). 3.4. HCA will not seek reimbursement for any invoice received after the 23rd month of the two-year federal filing deadline. 3.4.1. Contractor must not bill and HCA must not pay for Services performed under this Contract if the Contractor has charged or will charge another agency of the State of Washington or any other party for the same Services. 4. Calculating the FFP and Generating an Invoice The Contractor is responsible for ensuring all data (including all RMTS and financial data) used to calculate the amount of FFP submitted to HCA for reimbursement is accurate, based on actual expenses incurred during the period of performance, and complies with all federal, state, NCA and CMS Regulations, the CAP, Manual, and this Agreement. The Contractor must certify the accuracy of all data used to calculate the amount of FFP by an Authorized Representative signing the A19 - 1A Invoice Voucher (A19). The Contractor must use a System that is statistically valid and in compliance with all state, and federal laws and Regulations whether through a third- party or other means as stated in the CAP to calculate the amount of FFP and generate a claim. 4.1. The Contractor must submit invoices to HCA for FFP on a quarterly basis. 4.2. All data used to calculate the FFP must be from the same period of service. 4.3. All data used to calculate the FFP must be the actual cost/expenditure and not approximated. 4.4. The FFP is determined by calculating the total adjusted costs, multiplying these costs by the adjusted RMTS results, and the applicable Medicaid Eligibility Rate (MER), adding any direct charges, and then applying the appropriate FFP rate. 4.5. The invoice must be generated within one hundred twenty (120) business days of the end of the quarter and generated based on following five components: 4.5.1. Cost pool construction; 4.5.2. Calculating allowable Medicaid administrative time via the System or direct charge method and documentation; Washington State Page 41 of 53 HCA IAA K4649 Health Care Authority Revised 10/2020