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sharing or other amounts, which have not otherwise been paid by a primary or secondary carrier in accordance with <br />regulatory standards for coordination of benefits, that are the Covered Person's financial responsibility under the <br />applicable Coverage Agreement. <br />3.5.2. Provider and each Contracted Provider agree, in the event of Payor's insolvency, to continue <br />to provide the services promised in the Coverage Agreement to Covered Persons for the duration of the period for <br />which premiums on behalf of the Covered Persons were paid to Company or Payor or until the Covered Person's <br />discharge from inpatient facilities, whichever time is greater. <br />3.5.3. Notwithstanding any other provision of this Agreement, nothing in this Agreement shall be <br />construed to modify the rights and benefits contained in the Covered Person's Coverage Agreement. <br />3.5.4. Provider and each Contracted Provider may not bill Covered Persons for Covered Services <br />(except for deductibles, copayments, or coinsurance) where Payor denies payment because Provider or a Contracted <br />Provider has failed to comply with the terms or conditions of this Agreement. <br />3.5.5. Provider and each Contracted Provider further agree (i) that the provisions of 3.5.1, 3.5.2, <br />353, 3.5.4 and 3.5.5 of this Section 3.5 shall survive termination of this Agreement regardless of the cause giving <br />rise to termination and shall be construed to be for the benefit of Covered Persons, and (ii) that these provisions <br />supersede any oral or written contrary agreement now existing or hereafter entered into between Contracted Provider <br />and Covered Persons or persons acting on their behalf. <br />3.5.6. If Provider or Contracted Provider contracts with other providers or facilities who agree to <br />provide Covered Services to Covered Persons with the expectation of receiving payment directly or indirectly from <br />Payor, such providers or facilities must agree to abide by the provisions of Subsections 3.5.1 through 3.5.7. <br />3.5.7. Provider acknowledges that willfully collecting or attempting to collect payment from a <br />Covered Person, knowing that collection to be in violation of this Section 3.5, constitutes a class C felony under RCW <br />48.80.030(5). <br />3.5.8. Mental/Behavioral Health Providers: In accordance with RCW 48.43.087 and RCW <br />48.43.087, nothing in this contract will prevent a mental/behavioral health practitioner and an enrollee from agreeing <br />to have services provided at the Covered Person's expense. If a mentalibehavioral health practitioner provides <br />services to an enrollee during an appeal or adverse certification process, the practitioner must provide written <br />notification to the enrollee that payment for services is the enrollee's responsibility, unless Health Plan elects to pay. <br />3.6. Terms and Conditions of Payment <br />3.6.1. Payor shall pay Provider and each Contracted Provider for Covered Services in accordance <br />with the applicable Compensation Schedule as soon as practical but subject to the following minimum standards: (a) <br />95% of the monthly volume of Clean Claims shall be paid within 30 days of receipt by Payor; (b) 95% of the monthly <br />volume of all claims shall be paid or denied within 60 days of receipt by Payor, except as agreed to in writing by the <br />Parties on a claim -by -claim basis. The date of receipt of a claim is the date the Payor or its agent receives either <br />written or electronic notice of the claim. Payor shall utilize a reasonable method for confirming receipt of claims and <br />responding to Provider or Contracted Provider inquiries thereof. <br />3.6.2. Failure to pay claims within these minimum standards will result in interest payments on <br />undenied and unpaid Clean Claims more than 61 days old until Payor meets the standards in this Section 3.6. Interest <br />shall be assessed at the rate of 1% per month, and shall be calculated monthly as simple interest prorated for any <br />portion of a month. Payor shall add the interest payable to the amount of the unpaid claim without the necessity of <br />the Provider or Contracted Provider submitting an additional claim. Any interest paid under this section shall not be <br />applied by the Payor to a Covered Person's deductible, copayment, coinsurance, or any similar obligation of the <br />Covered Person. <br />PPA WA - Kittitas County Public Health - 05.07.2025 - ICMProviderAgreement_360268 Page 9 of 24 <br />