SHJ25-007 Kittitas County and Wellpoint Agreement - PARTIALLY EXECUTED

Home Browse Search

7.2 Negotiation of Disputes. In the event of a dispute arising out of this Agreement that is not resolved by, or is not within the scope of relationship management set forth in the Agreement, or that is not resolved by informal discussions among the parties, the parties shall negotiate the dispute. Any party may initiate negotiation by sending a written description of the dispute to the other parties by certified or registered mail or personal delivery. The description shall explain the nature of the dispute in detail and set forth a proposed resolution, including a specific time frame within which the parties must act. The party receiving the letter must respond in writing within thirty (30) days with a detailed explanation of its position and a response to the proposed resolution. Within thirty (30) days of the initiating party receiving this response, principals of the party who have authority to settle the dispute will meet to discuss the resolution of the dispute. The initiating party shall initiate the scheduling of this negotiating session. 7.2.1 In the event the parties are unable to resolve the dispute following the negotiation, a party shall have the right to pursue all available remedies at law or equity, including injunctive relief. 7.3 Dispute Resolution. Except as expressly permitted under Regulatory Requirements or regulations governing dispute resolution, no process for the resolution of disputes arising out of a participating provider contract shall be considered fair under RCW 48.43.055 unless the process meets all the provisions of WAC 284-170-440. 7.3.1 A dispute resolution process may include an initial informal process but must include a formal process for resolution of all contract disputes. 7.3.2 Wellpoint may have different types of dispute resolution processes as necessary for specialized concerns such as provider credentialing or as otherwise required by law. For example, disputes over Government Program coverage of Covered Services are subject to the grievance procedures established for Members. 7.3.3 Wellpoint must allow not less than thirty (30) days after the action giving rise to a dispute for providers to complain and initiate the dispute resolution process. 7.3.4 Wellpoint may not require alternative dispute resolution to the exclusion of judicial remedies; however, Wellpoint may require alternative dispute resolution prior to judicial remedies. 7.3.5 Wellpoint must render a decision on provider complaints within a reasonable time for the type of dispute. In the case of billing disputes, Wellpoint must render a decision within sixty (60) days of the complaint. 7.4 Period of Limitations. Unless otherwise provided for in this Agreement or Participation Attachment(s), neither party shall commence any action at law or equity against the other to recover on any legal or equitable claim arising out of this Agreement ("Action") more than six (6) years after the events which gave rise to such Action; provided, however, this six (6) year limitation shall not apply to Actions by Wellpoint against Provider related to fraud, waste or abuse which shall be subject to the period of limitations set forth in applicable Regulatory Requirements. In the situation where Provider believes that Wellpoint underpaid a Claim, the Action arises on the date when Wellpoint first denies the Claim or first pays the Claim in an amount less than expected by Provider. In the situation where Wellpoint believes that it overpaid a Claim, the Action arises when Provider first contests in writing Wellpoint's notice to it that the overpayment was made. The deadline for initiating an Action shall not be tolled by the appeal process, provider dispute resolution process or any other administrative process. To the extent an Action is timely commenced, it will be administered in accordance with Article VII of this Agreement. ARTICLE VIII TERM AND TERMINATION 8.1 Term of Agreement. This Agreement shall commence at 12:01 AM on the Effective Date for a term of one (1) year, and shall continue automatically in effect thereafter for consecutive one (1) year terms unless otherwise terminated as provided herein. 8.2 Termination Without Cause. Either party may terminate this Agreement without cause at any time by giving at least one hundred eighty (180) days prior written notice of termination to the other party. Notwithstanding the foregoing, should a Participation Attachment(s) contain a longer without cause termination period, the Agreement shall continue in effect only for such applicable Participation Attachment(s) until the termination without cause notice period in the applicable Participation Attachment(s) ends. Washington Enterprise Provider Agreement PCs 9 1183932156 02024 July— Wellpoint Washington, Inc. 05/05/2025