SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED

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outside a CHPW Benefit Plan on any terms or conditions a Member chooses. Nothing herein shall be construed to bind CHPW to pay for services delivered outside a CHPW Benefit Plan. IV. BILLING AND REIMBURSEMENT 4.1 For all billing and reimbursement activities, the parties shall comply with applicable billing instructions, practices and policy guidelines herein and as published and periodically updated in the Provider Manual and, as applicable, by HCA and CMS instructions and coverage/non- coverage determinations. If there is a conflict between the substance or interpretation of the HCA Billing Instructions applicable to the fee -for -service Medicaid program and the Provider Manual, the Provider Manual shall control. If there is a conflict between the substance or interpretation of CMS instructions or determinations on coverage and the Provider Manual, the CMS instructions or determinations shall control. 4.2 Claims and Encounter Submission. 4.2.1 Facility shall comply with the claims, encounter reporting, payment, and billing procedures set forth in the Provider Manual and submit Clean Claims for Covered Services rendered to the address set forth on the Member's identification card in nationally approved standard formats and through a CHPW approved clearinghouse. Without limiting the generality of the foregoing, encounters shall be submitted within thirty (30) days of the end of the month in which the service was rendered. Except as otherwise stated, Facility shall use best efforts to submit claims/encounters electronically. 4.2.2 Upon request, Facility shall furnish all information reasonably required by CHPW to substantiate the provision of and charges for Covered Services, at no charge to CHPW. Claim approval and payment for claims or encounters are contingent upon receipt of complete and accurate information from Facility. 4.2.3 To the extent that Facility is billing for pharmacy claims, Facility shall be subject to the Provider Manual terms with regard to prior authorization procedures including policies regarding emergency fill authorizations. 4.3 Reimbursement. 4.3.1 CHPW shall reimburse Facility for timely submitted Clean Claims for Covered Services it provides to Members in accordance with this Section IV and the applicable Benefit Plan Exhibit(s) in Exhibit B. Facility shall accept such reimbursement plus any applicable Cost Sharing amounts as payment in full for Covered Services rendered by Facility and Facility -Based Providers. 4.3.2 CHPW shall not pay a claim received (i) more than three hundred and sixty-five (365) calendar days after the date a Covered Service was rendered or the date of discharge, whichever is later or (ii) more than sixty (60) calendar days after Facility first receives notice that CHPW is a secondary payer under applicable coordination of benefit procedures. 2020 Facility Agmt— Template Page 12 of 51 Contract #{Contract #}-{PRC Agreement ID}