SHJ25-011 UNITED HEALTHCARE & KCJ Carceral 2025 Medicaid Contract - PARTIALLY EXECUTED

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Payment Appendix —Washington Medicaid and CHIP Applicability This Appendix applies to covered services rendered by you to customers covered under the following types of benefit contracts, as described in the agreement: Washington Medicaid and CHIP Benefit Contracts. SECTION 1 Payment for Covered Services 1.1 Payment. Your contract rates for covered services are 100% of the amounts as published in the Washington Medicaid fee schedule by the applicable state agency. This fee schedule is the "primary fee source" for contract rates. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. For certain CPT codes, we may use a higher amount than the contract rate described above. If we do pay a higher amount, then at a future date we may revert to the contract rate described above. In these circumstances, we will not attempt to collect as overpayments amounts paid higher than the contract rate. In the event that a specific dollar amount is not published in a fee source, then the contract rate for covered services will be priced at 40% of eligible charges. Eligible charges are Customary Charges for covered services. If an applicable state or federal program is available to provide items or payment directly to you for specific covered services for customers subject to this Appendix that would otherwise be payable under this Appendix, the applicable program will apply and not this Appendix. (For example, the Vaccines For Children program currently provides vaccines free of charge, and therefore no amount will be payable under this Appendix for vaccines within the Vaccines For Children program. However, the administration of such vaccine is payable under this Appendix, because payment is not provided to professionals under the Vaccines For Children program for vaccine administration.) The contract rates established by this appendix are all-inclusive, including without limitation any applicable taxes, for all covered services provided to the customer. Unless specifically indicated otherwise, amounts listed in this fee schedule represent global fees and may be subject to reductions based on appropriate modifiers (for example, professional and technical modifiers). Any co -payment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount to be paid by us. This information is subject to the confidentiality provisions of this agreement. 1.2 Routine Maintenance. We routinely update this fee schedule in response to changes published by the primary fee source, such as fee amount changes. We will use reasonable commercial efforts to implement the fee schedule changes in its systems within 90 days after final publication and make them effective in our system on the effective date of the change by the primary fee source. However, claims already processed prior to the change being implemented by us will not be reprocessed unless otherwise required by law. We also routinely update this fee schedule in response to coding changes as described in this agreement. When implementing coding updates, we will apply the same percentages as set forth above in section 1.1 and the then current value of the published code to determine the contract rate. We will use reasonable commercial efforts to implement such changes within 90 days from the date of publication. However, claims already processed prior to the change being implemented by us will not be reprocessed unless otherwise required by law. CS_SMGA_PAYAPX WA03.13 Parties bound to confidentiality under Section'About data and confidentiality' -17-