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SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED
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2025-06-17 10:00 AM - Commissioners' Agenda
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SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED
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Last modified
6/12/2025 12:54:55 PM
Creation date
6/12/2025 12:49:59 PM
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Meeting
Date
6/17/2025
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve Agreement SHJ25-009 Community Health Plan of Washington - 1115 Medicaid Re-Entry Initiative
Order
16
Placement
Consent Agenda
Row ID
132242
Type
Contract
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4.3.3 CHPW reserves the right to change the reimbursement rates set forth on each Benefit <br />Plan Exhibit in Exhibit B, attached hereto and incorporated herein, by written notice to <br />Facility in accordance with changes in rates paid by applicable federal, state or other third - <br />party payers. Such reimbursement shall be accepted by Facility as payment in full. <br />4.3.3.1 CHPW will provide the Facility at least sixty (60) days' notice of changes that <br />affect the reimbursement rates pursuant to Section 7.6.1 below unless changes to federal <br />or state law or regulations make such advance notice impossible, in which case notice <br />shall be provided as soon as possible. Facility may terminate the contract pursuant to <br />Section 6.3 if it does not consent to the changes. <br />4.3.3.2 The parties acknowledge that configuring new rates into CHPW's reimbursement <br />system to begin paying claims at a new rate requires up to 30 days. Therefore, in <br />situations where federal or state rate changes do not allow CHPW to provide 60 days <br />advance notice to Facility, the new rates will be implemented on the later of the date <br />CHPW has completed configuring its system or on the published effective date of the <br />new rates. Where a change allows for 60 days' notice, the new rates will be implemented <br />on the published effective date of the rate change. <br />4.3.3.3 CHPW will apply new rates only to claims received on and after the <br />implementation date defined in the preceding Section 4.3.2.2. If such action results in a <br />substantial negative impact to either party, the impacted party may request that the parties <br />negotiate a settlement payment in lieu of retroactive adjustment of individual claims. <br />4.3.4 As set forth in its Provider Manual, CHPW shall not reimburse Facility for services <br />rendered in conjunction with commonly recognized grossly negligent acts or Hospital <br />Acquired Conditions including, those referred to as Serious Reportable Adverse Events and <br />Never Events. <br />4.3.5 CHPW shall pay not less than ninety-five percent (95%) of all Clean Claims received <br />from Facility within thirty (30) days of receipt, and shall pay or deny ninety-five percent <br />(95%) of all claims received from Facility within sixty (60) days of receipt, unless otherwise <br />agreed to by the parties on a claim -by -claim basis. A Clean Claim is "received" on the date <br />CHPW, or its appointed agent, receives either written or electronic notice of the claim. If <br />CHPW fails to meet its obligations under this paragraph, CHPW shall pay Facility interest at <br />the rate of one percent (1 %) per month of the contract rate of all unpaid Clean Claims that <br />have not been denied, and which have aged sixty one (61) or more days, until such time as <br />CHPW is again in compliance with these requirements. <br />4.4 Coordination of Benefits and Third -Party Payment. <br />4.4.1 Facility will cooperate with CHPW's coordination of benefits, subrogation and third - <br />party payment policies as set forth herein and in the Provider Manual. CHPW will not <br />unreasonably delay payment of a claim by reason of the application of its coordination of <br />benefits policies. <br />2020 Facility Agmt—TemplatePage 13 of 51 Contract #(Contract #1-{PRC Agreement ID) <br />
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