SHJ25-009 KCJ AND CHPW - PARTIALLY EXECUTED

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4.4.2 Facility shall promptly notify CHPW if it becomes aware that a Member has a subrogation claim or right to reimbursement from a third party and assist CHPW in arranging for assignment of such right to CHPW for collection. Facility shall also notify CHPW of Members that may approach stop -loss deductibles, have other insurance coverage available, or be eligible for Social Security coverage. 4.4.3 Except as otherwise required by Chapter 284-51 WAC, under no circumstances shall CHPW reimburse Facility any amount greater than that provided for hereunder. If Facility has received payment from another coverage plan or entity that has primary payment responsibility under coordination of benefits rules, and that payment is equal to or greater than the rates set forth herein, Facility may not seek additional reimbursement from CHPW. In addition, Facility agrees to promptly refund to CHPW any amount CHPW has already paid to Facility which, when added to amounts paid by another coverage plan or entity for the same Covered Services, are in excess of the rates set forth in this Agreement. 4.5 Retrospective Review and Recovery Rights. 4.5.1 CHPW reserves the right to assure through audit and retrospective evaluation of a Member's documented medical care that, based on the information available to the attending physician or order provider at the time services were provided, services provided were Medically Necessary and claims were accurately coded. Such review or audit may result in denial of claims for services on the basis of Medical Necessity or errors in claims submission and may adversely impact payment. 4.5.1.1 CHPW may retrospectively deny a claim (a) if it is determined that prior authorization was based upon a material misrepresentation by Facility or a Facility -Based Provider, and/or (b) if information provided to CHPW is materially different from information that was reasonably available at the time of the original determination. 4.5.2 Any payments made to Facility by CHPW that are determined to be inappropriate in accordance with applicable law, or to which Facility is not entitled under the terms of this Agreement or the Provider Manual, shall be considered an overpayment. Overpayments shall be refunded to CHPW within thirty (30) days of the date Facility is notified of the overpayment or within sixty (60) days of identification of an overpayment by Facility, whichever is earlier. Alternatively, CHPW may, in its discretion, immediately offset or recoup any and all overpayments or other amounts owed by Facility to CHPW against amounts owed by CHPW to Facility. 4.5.3 Facility agrees that all recoupment and any offset rights under this Agreement will constitute rights of recoupment authorized under State or federal law and that such rights will not be subject to any requirement of prior or other approval from any court or other government authority that may now have or hereafter have jurisdiction over Facility. Notwithstanding the foregoing, except in the case of fraud, CHPW may not request (a) a refund of a payment previously made to satisfy a claim unless CHPW does so in writing within twenty-four (24) months (or within thirty (30) months for reasons related to coordination of benefits) in accordance with RCW 48.43.600 or (b) payment of a contested 2020 Facility Agmt—TemplatePage 14 of 51 Contract #{Contract #)-1PRC Agreement ID)