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

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205 W 5th Ave Ste l Ellensburg Address: Address: WA, 98926 Signature: Signature: Print Print Name: Name: Title: Title: Date: Date: � � � �i ✓ �� For office use only: Deal Number: 75928271 Month, day and year in which agreement is first effective: What you will do You need to be credentialed in accordance with our Credentialing Plan, as referenced in Appendix 1, for the duration of this agreement. You must notify us in a timely manner about certain services you provide in accordance with our Administrative Guide so that we can provide our customers with the services we have committed to provide. If you do not so notify us about these services, you will not be reimbursed for the services, and you may not charge our customer. Within one year of the effective date of this agreement, you must conduct business with us entirely on an electronic basis to the extent that we are able to conduct business electronically (described in the Administrative Guide), including but not limited to determining whether your patient is currently a customer, verifying the customer's benefit, and submitting your claim. We will communicate enhancements in UnitedHealthcare Online® functionality as they become available and will make information available to you as to which products are supported by UnitedHealthcare Online. You must submit your claims within 90 days of the date of service. After we receive your claim, if we request additional information in order to process your claim, you must submit this additional information within 90 days of our request. If your claim or the additional information is not submitted within these timeframes, you will not be reimbursed for the services, and you may not charge our customer. You will submit claims only for services performed by you or your staff. Pass through billing is not payable under this agreement and may not be billed to our customer. For laboratory services, you will only be reimbursed for the services that you are certified through the Clinical Laboratory Improvement Amendments (CLIA) to perform, and you must not bill our customers for laboratory services for which you are not certified. You will submit claims that supply all applicable information. These claims are complete claims. Further information about complete claims is provided in our Administrative Guide. If you disagree with our payment determination on a claim, you may submit an appeal as described in our Administrative Guide. UHC/,SMGA.03.12. WA Parties bound to confidentiality under Section 'About data and confidentiality' -3-