SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED

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170-421(3) (a), (b), (c), (d), and (e). Provider agrees and understands that willfully collecting or attempting to collect an amount from a Member knowing that collection to be in violation of the participating provider or facility contract constitutes a class C felony under RCW 48.80.030(5). 2.7 Recouoment/Offset/Adjustment for Overoayments. Except as expressly permitted under Regulatory Requirements, Wellpoint shall be entitled to request a refund in an amount equal to any overpayments made by Wellpoint to Provider provided that any refund requests by Wellpoint shall be made in conformance with RCW 48.43.600 timelines for notice and objection, as such section may be amended or recodified from time to time. Upon determination that an overpayment is due from Provider to Wellpoint, Wellpoint shall first give Provider notice of overpayment and request reimbursement via check for such an overpayment. If Provider fails to contest the request in writing within thirty (30) days following the date of Provider's receipt of such notice, the request is deemed accepted. Provider then must submit a check to Wellpoint for such overpayment, or Wellpoint shall be entitled to offset such overpayment against other amounts due and payable by Wellpoint to Provider. 2.7.1 Pursuant to RCW 48.43.605, except in the case of fraud, or coordination of benefits as provided below in Section 2.7.2, Provider may not: (a) request additional payment from Wellpoint to satisfy a Claim unless Provider does so in writing to Wellpoint within twenty-four (24) months after the date that the Claim was denied or payment intended to satisfy the Claim was made; or (b) request that the additional payment be made any sooner than six (6) months after receipt of the request. Any such request must specify why the Provider believes Wellpoint owes the additional payment. 2.7.2 Provider may not, if doing so for reasons related to coordination of benefits with another carrier or entity responsible for payment of a Claim: (a) request additional payment from Wellpoint to satisfy a Claim unless Provider does so in writing to Wellpoint within thirty (30) months after the date the Claim was denied or payment intended to satisfy the Claim was made; or (b) request that the additional payment be made any sooner than six (6) months after receipt of the request. Any such request must specify why the Provider believes Wellpoint owes the additional payment, and include the name and mailing address of any entity that has disclaimed responsibility for payment of the Claim. 2.7.3 Pursuant to RCW 48.43.600, except in the case of fraud, or as provided below in Sections 2.7.4 and 2.7.5, Wellpoint may not: (a) request a refund from a Provider of a payment previously made to satisfy a Claim unless it does so in writing to the Provider within twenty-four (24) months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than six (6) months after receipt of the request. Any such request must specify why Wellpoint believes Provider owes the refund. If Provider fails to contest the request in writing to Wellpoint within thirty (30) days of its receipt, the request is deemed accepted and the refund must be paid. 2.7.4 Wellpoint may not, if doing so for reasons related to coordination of benefits with another carrier or entity responsible for payment of a Claim: (a) request a refund from Provider of a payment previously made to satisfy a Claim unless it does so in writing to Provider within thirty (30) months afterthe date that the payment was made; or (b) request that a contested refund be paid any sooner than six (6) months after receipt of the request. Any such request must specify why Wellpoint believes Provider owes the refund, and include the name and mailing address of the entity that has primary responsibility for payment of the Claim. If Provider fails to contest the request in writing to Wellpoint within thirty (30) days of its receipt, the request is deemed accepted and the refund must be paid. 2.7.5 Wellpoint may at any time request a refund from Provider of a payment previously made to satisfy a Claim if: (a) a third party, including a government entity, is found responsible for satisfaction of the Claim as a consequence of liability imposed by law, such as tort liability; and (b) Wellpoint is unable to recover directly from the third party because the third party has either already paid or will pay Provider for the health services covered by the Claim. 2.7.6 If any provision in this Agreement conflicts with this section, this section shall prevail. However, nothing in this section prohibits Wellpoint from choosing at any time to make additional payments to a Provider to satisfy a Claim. 2.7.7 For purposes of this section, "refund" means the return, either directly or through an offset to a future Claim, of some or all of a payment already received by Provider. Washington Enterprise Provider Agreement PCs 4 1183932156 © 2024 July— Wellpolnt Washington, Inc. 05/05/2025