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

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in this agreement shall be construed to modify the rights and benefits contained in the enrolled participant's benefit contract. You may not bill the enrolled participant for covered health services (except for copayments, coinsurance and/or deductibles) where we or a participating entity deny payments because you have failed to comply with the terms or conditions of this agreement. You further agree (a) that the provisions of this section shall survive termination of this agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of the enrolled participants and (b) that this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between you and enrolled participants or persons acting on their behalf. If you contract with other health care providers who agree to provide covered health services to enrolled participants with the expectation of receiving payment directly or indirectly from us or a participating entity, such providers must also agree to abide by this section. B. Collection of Amounts from Enrollees. If you willfully collect or attempt to collect an amount from an enrollee knowing that collection to be in violation of this agreement, such collection or attempts to collect will constitute a class C felony under Washington Statutes. C. Continuation of Covered Health Services after Termination. In the event the agreement between you and us is terminated and in the event you are a primary care physician and you are rendering covered health services to enrolled participants, you agree to continue providing such covered health services pursuant to the terms and conditions of this addendum and this agreement (a) for at least sixty (60) days following termination; and (b) in the case of group benefit plans, until the end of the next open enrollment period. D. Subcontractors. You shall ensure that providers and facilities subcontracting with you comply with the applicable requirements set forth in this agreement and the Washington Administrative Code. E. Equal Treatment of Enrolled Participants. You and we each agree to treat all enrolled participants equally, regardless of whether the enrolled participant's enrollment is through a private purchaser or a publicly funded program such as Medicare or Medicaid. T. Audit of Billing Records. To the extent the agreement between you and us allows us the right to audit your billing records, you shall have the right to audit our denial of your claims under the same terms and conditions that the agreement sets forth for our audit of your billing records. G. Administrative Protocols, Policies and Programs. Pursuant to WAC § 284-170-421, we shall notify you of your responsibilities with respect to our applicable administrative protocols, policies and programs, including but not limited to payment terms, utilization management, quality assessment and improvement programs, credentialing, grievance, appeal and adverse benefit determination procedures, data reporting requirements, pharmacy benefit substitution process, confidentiality requirements and any applicable federal or state requirements. You shall comply with the Carrier's protocols, policies and programs. You hereby acknowledge that you have been given the opportunity prior to contracting to access the Carrier's Administrative Guide at no cost to you by way of Carrier's website or by hardeopy upon request to the Carrier. Therefore, you have had the opportunity to learn of your responsibilities under the Administrative Guide. The Administrative Guide describes, among other things, administrative and operational protocols and procedures, such as claims submission, and clinical submission requirements. Documents, protocols, procedures, and other administrative policies and programs referenced in the agreement between you and us shall be available for review by you prior to contracting and U1ICSMGA.REGAPK09.24.WA -20-