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

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WASHINGTON STATE PROGRAMS REGULATORY REQUIREMENTS APPENDIX PROVIDER THIS WASIIINGTON STATE PROGRAMS REGULATORY REQUIREMENTS APPENDIX (this "Appendix") supplements and is made part of the provider agreement (the "Agreement") between UnitedHealtheare of Washington, Inc. (referred to in this Appendix as "Carrier") and the party named in the Agreement ("Provider"). SECTION 1 APPLICABILITY The requirements of this Appendix apply to "State Program" (as defined below) benefit plans sponsored, issued or administered by Carrier, including the State's Apple Health and related programs, and Washington Benefit Plans for the Uninsured, as governed by the State's designated regulatory agencies. In the event of a conflict between this Appendix and other appendices or any provision of the Agreement, the provisions of this Appendix shall control except with regard to benefit plans outside the scope of this Appendix or unless otherwise required by law. In the event Carrier is required to amend or supplement this Appendix as required or requested by the State to comply with federal or State regulatory requirements, Provider agrees that Carrier shall be permitted to unilaterally initiate such additions, deletions or modifications. SECTION 2 DEFINITIONS Unless otherwise defined in this Appendix, all capitalized terms shall be as defined in the Agreement. For purposes of this Appendix, the following terms shall have the meanings set forth below; provided, however, in the event any definition set forth in this Appendix or the Agreement is inconsistent with any definitions under the applicable State Program, the definitions shall have the meaning set forth under the applicable State Program. 2.1 Administrative Function(s): Any obligation of Carrier under a State Contract other than the direct provision of Covered Services to Covered Persons. Administrative Functions include, but are not limited to, utilization/medical management, claims processing, Covered Person grievances and appeals, and the provision of data or information necessary to fulfill any of Carrier's obligations under a State Contract. 2.2 Claim: A bill for services, a line item of service or all services for one Covered Person within a bill. 2.3 Clean Claim: A Claim that can be processed without obtaining additional information from the provider of the service or from a third party. 2.4 Covered Person: An individual who is currently enrolled with Carrier for the provision of services under a State Program. A Covered Person may also be referred to as an Enrollee, Member or Customer under the Agreement. 2.5 Contracted Services: Covered Services that are to be provided under the terms of the State Contract. 2.6 Covered Services: Health care services that HCA determines are covered for Covered Persons. UHUSTATE PROGRAMS RF.GAPX WA.02.25 28