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2.7 Washlnglon Entefprise Provlder Agreemont PCS @ 2024 July- W€llpoht WashlrEton, lnc. 170-421(3) (a), {b), (c), (d), and (e), Provlder agr€}es and understands that willfully collecting or attempting to collect an amount from a Member knowing that collectlon io be in violation of the participating provider or facility contract constitutes a class C felony under RCW 48.80.030(5). BecouomentlOffge.t/Adjustment for Overpayments. Except as expressly permitted under Regulatory Requirements, Wellpolnt shall be entitled to request a refund in an amount equal to any overpayments made by Wellpolnt to Provider provided that any refund requests by Wellpoint shall be made in conformance with RCW 48.43.600 timelines for notice and obiection, as such section may be amended or recodified from time to time. Upon determination that an overpayment ls due from Provider to Wellpoint, Wellpoint ehall flrst give Provider notice of overpayment and requesl reimbursement vla check for such an overpayment. tf Provider fails to contest the request in writing within thirly (30) days following the date of Provlder's roceipt of such notice, the request is deemed accepted, Provider then must submit a check to Wellpolnt for such gvgpqymgnt or Wellpoint shall be entitled to offset such overpayment agalnst other amounts due and payabte by Wellpoint to Provlder. 2.7,'l Pursuant to RCW 48.43.605, except In the case of fraud, or coordination of benefits as provided below in Section 2.7.2,Provlder may not (a) rcquest additional payment from Wellpoint lo'satisff a Claim unless Provider does so in writing to Wellpoint within twenty-four (24) montrs after the date that the Clalm was denied or payment intended to satisfy the Claim was made; or (b) request that the additional payment be made any sooner than slx (6) months after receipt of the request. Any such request must specify why the Provider believes Wellpoint owes the additional payment. 2.7.2 Provlder may not, if dolng so for reasons related to coordination of beneflts wlth another carrier or entity r€sponsible for payment of a Claim: (a) request additional payment from Wellpoint to satlsff a Claim unless Provider does $o in wrltlng to Wellpoint wlthin thirty (30) months after the date the Claim was denlsd or payment intended to satlsfiT the Clalm was made; or (b) request that the additional payment be made any sooner than six (6) months afrer receipt of the request. Any such request must speciff why the Provider believes Wellpoint owes the additional payment, and include lhe name and mailing address of any entity that has disclaimed responslbility for paymont of the Claim. 2.7.3 Pursuant to RCW 48.43.000, except in the case of fraud, or as provided below in Sections 2.7.4 and 2.7.5, Wellpoint may nol (a) request a refund from a Provider of a payment previously made to satisfy a Claim unless lt does so in writing to the Provider within twenty-four (24) months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than slx (6) months after receipt of the request. Any such requeet must specifu why Wellpoint believes Provider owes the refund. lf Provider fails to contest the request in writing to Wellpoint withln thirty (30) days of its receipt, the request ls deemed accepted and the refund must be paid, 2.7.4 Wellpoint may not, if doing so for reasons related to coordlnation of benefits with another carrier or entlty responsible for payment of a Claim: (a) request a refund from Provider of a payment prevlously made to satisfo a Clalm unless lt does so in writing to Provider within thirty (30) months afterthe date that the payment was made; or (b) request that a contested refund be paid any sooner than six (6) months after receipt of the request. Any such request must speciflr why Wellpoint believes provider owes the refund, and include lhe name and mailing address of the entity that has primary responsiblllty for payrnent of the Claim. lf Provider fails to contest the request in wdting to Wellpolnt within lhidy (30) days of its receipt, the request ls deemed accepted and the retund must be paid, 2.7 .5 Wellpoint may at any timo request a refund from Provider of a payment previously m'ade to satisfy a Claim if: (a) a third party, including a government entity, is found responsible for satisfacflon of the Claim as a consequence of liabllity imposed by law, such as tort liability; and (b) Wellpoint is unable to recover directly from the third party because the thlrd party has either already paid or will pay Provider forthe health services covered by the Claim. 2.7,6 lf any provision in this Agreement confllcts with this section, this section shall prevail. However, nothing in this section prohlblts Wellpolnt from choosing at any time to make additional payments to a Providerto satisff a Claim. 2.7 .7 For purposes of this section, "r6fund" means the return, eilher directly or through an offset to a future Claim, of some or all of a payment already received by Provider. 4 1 1 839321 56 0510612025