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(b) Your Requests for Additional Pam. Except in cases of fraud or as otherwise <br />provided in this section and RC W 48.43.605, All requests by you for additional <br />payment to satisfy a claim must be made in writing within twenty-four (24) months <br />after the date that the claim was denied or initial payment intended to satisfy the <br />claim was made; (ii) Requests for additional payments to satisfy claims that relate to <br />coordination of benefits must be made within thirty (30) months after the date that the <br />payment was made; and (iii) you may not request a contested refund to be paid any <br />sooner than six (6) months after receipt of the request. Requests for additional <br />payments must specify why you believe we or the participating entity owes the <br />additional payment. Requests for additional payment that involve coordination of <br />benefits must include the name and mailing address of the entity that has disclaimed <br />responsibility for payment of the claim. <br />5. The following provisions are added to the end of the section and do not replace section <br />"How long our agreement lasts; how it gets amended; and how it can end" of the <br />agreement: <br />A. Termination. We each agree to provide written notice to each other in the form and for the <br />length of time as provided in the Agreement, but in no case less than sixty (60) days, before <br />terminating the agreement between you and us and this appendix without cause. Pursuant to <br />WAC 284-170-421, in the event the agreement is terminated for any reason, we or the <br />participating entity must make a good faith effort to ensure written notice is provided no <br />later than 30 calendar days prior to the effective date of the termination, or immediately for <br />a terminations for cause that results in less than thirty (30) calendar days' notice of <br />termination to you, to members who (1) are seen by you as a primary care physician, (2) are <br />seen on a regular basis by a specialist, or (3) have a standing referral to you. <br />B. Minimum Notice Required for Amendments Subject to This Appendix. You must be <br />given reasonable notice of not less than sixty days of material changes that affect <br />compensation and health care service delivery unless changes to federal or state law or <br />regulations make such advance notice impossible, in which case notice shall be provided as <br />soon as possible. <br />However, you may reject a material amendment as specifically defined in RCW 48.39.005 <br />without terminating the Agreement. Your rejection of the material amendment will not affect the <br />terms of the Agreement. <br />Carrier will provide at least 30 days' notice of any other regulatory amendment, unless a shorter <br />notice is necessary in order to accomplish compliance. <br />6. The following provisions are added to the end of the section and do not replace section <br />"About data and confidentiality" of the agreement: <br />A. Confidentiality. We each agree to comply with all applicable state and federal laws <br />regarding the confidentiality of medical information relating to members. <br />B. Access to Enrolled Participant Health Records. You shall be required to make enrolled <br />participants' health records available to appropriate state and federal authorities involved in <br />assessing the quality of care or investigating complaints, grievances, appeals or review of <br />any adverse benefit determinations from enrolled participants subject to applicable state and <br />federal laws related to the confidentiality of medical or health records. You are required to <br />cooperate with audit reviews of encounter data in relation to the administration of health <br />plan risk adjustment and reinsurance programs. <br />UIIC/SMGA.REGAPX 09.24. WA -24- <br />