SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED

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DRG Rate, Encounter Rate, Global Case Rate, Per Diem Rate, Per Relative Value Unit (RVU), and Per Visit Rate, then individual services billed shall not be reimbursed separately, unless otherwise specified in the PCS Attachment(s). Reimbursement for Subcontractors. Plan shall not be liable for any reimbursement in addition to the applicable Wellpoint Rate as a result of Provider's use of a subcontractor. Provider shall be solely responsible to pay subcontractors for any Health Services, and shall via written contract, contractually prohibit such subcontractors from billing, collecting or attempting to collect from Wellpoint, Plan or Members. Notwithstanding the foregoing, if Wellpoint has a direct contract with the subcontractor, the direct contract shall prevail over this Agreement and the subcontractor shall bill Wellpoint under the direct contract for any subcontracted services, with the exception of nursing services provided for Home Infusion Therapy, or unless otherwise agreed to by the parties. Tax Assessment and Penalties. The Wellpoint Rates in this Agreement include all sales and use taxes and other taxes on Provider revenue, gross earnings, profits, income and other taxes, charges or assessments of any nature whatsoever (together with any related interest or penalties) now or hereafter imposed against or collectible by Provider with respect to Covered Services, unless otherwise required by Agency pursuant to Regulatory Requirements. Neither Provider nor Plan shall add any amount to or deduct any amount from the Wellpoint Rates, whether on account of taxes, assessments, tax penalties or tax exemptions. Updates to Wellpoint Rate(s) Based on External Sources. Unless otherwise required by Regulatory Requirements, and notwithstanding any proprietary fee schedule(s)/rate(s)/methodologies, Wellpoint shall use commercially reasonable efforts to update the Wellpoint Rate(s) based on External Sources, which include but are not limited to, i) CMS Medicare fee schedule(s)/rate(s)/methodologies; ii) Medicaid or State Agency fee schedule(s)/rate(s)/methodologies; iii) vendor fee schedule(s)/rate(s)/methodologies; or iv) any other entity's published fee schedule(s)/rate(s)/methodologies (collectively "External Sources") no later than sixty (60) days after Wellpoints receipt of the final fee schedule(s)/rate(s)/methodologies change from such External Sources, or on the effective date of such final fee schedule(s)/rate(s)/methodologies change, whichever is later. The effective date of such final fee schedule(s)/rate(s)/methodologies change shall be the effective date of the change as published by External Sources. Fee schedule(s)/rate(s)/methodologies will be applied on a prospective basis. Claims processed prior to the implementation of the new Wellpoint Rate(s) in Wellpoint's payment system shall not be reprocessed, however, if reprocessing is required by Regulatory Requirements, and such reprocessing could result in a potential under and/or over payment to a Provider, then Plan may reconcile the Claim adjustments to determine the remaining amount Provider owes Plan, or that Plan owes to Provider. Any resultant overpayment recoveries (i.e. Provider owes Plan) shall occur automatically without advance notification to Provider. Unless otherwise required by Regulatory Requirements, Wellpoint shall not be responsible for interest payments that may be the result of a late notification by External Sources to Wellpoint of fee schedule(s)/rate(s)/methodologies change. Washington Enterprise Provider Agreement PCS 33 1183932156 © 2024 July- Wellpoint Washington, Inc. 05/05/2025