Fully executed agreement - Laserfiche WebLink

Home Browse Search

ATTACHMEI{T A: Medicai4 Network: CCCWA EXHIBITA-6 APPLEIIEALTfl COMPENSATION S CIIEI}I]I,E ANCILLARY SERVICES CORRECTIONAL }'ACILITY Kittitas County Public Health This Compensation Schedule sets forth the maximum reimbursement amounts for the provision of Covered Services to Covered Persons in a Medicaid Produot offered through Health Plan and referred to as Apple Health. For Covered Services rendered to a Covered Person and billed under a Contracted Provider's tax identification number (.TN') that has been designated by the Payor as subject to this Comfensation Schedule, Payor shall pay or arrange for payment of a Clean Claitn for Covered Services rendered by the Contracted Provider according to the terms of the Agreement and this Compensation Schedule, Pa)arrent undEr this Compensation Schedule is subject to the requirements set forth in the Agreement. For corectional facility Covered Services provided to Covered Persons, Contracted Provider's maximum oompensation shall be the Allowed Amount. Exoept as otherwise provided in this Compensation Schedule the Allowed Amount is the lesser of: (i) the Contracted Provider's Allowable Chargeq or (ii) 100% of the State's Medicaid fee schedule in effect on the date of service. If there is no established payment amount on the Payor's Medicaid fee schedule for a Covered Service provided to a C.overed Person, Payor may establish a payment amount to appiy in determining the Allcwed Arnount. Until such time as Payor establishes such a payment amount, Contracted Provider's Allowed Amount shall be 25o/o of frte Contracted Provider's Allowable Charge. Ad ditional P rovisions : 1. Code Chanee Updates. Paycr utilizes nationally recogrrized coding structures (including, without limitation, revenue codes, CPT codes, HCPCS codes, ICD codes, national drug codes, ASA relative valueso etc., or their successors) for basic coding and descriptions of the ser'vices rendered- Updates to billing-related codes shall become effective on tlre clate ('Code Change Effective Date') that is the later of: (i) the first day of the month following 60 days after publication by the governmental agency having authority over the applicable product of such govemmental agency's acceptance of such code updates, (ii) the efflective date of sush code updates as determined by such goverrunental agency or (iii) if a date is not established by such govemmental agency or the product is not regulatecl by such govemmental agency, the date that changes are made to nationally recogtizsd codes. Such updates may include changes to service grouprngs. Claims processed prior to the Code Change Effective Date shall not be reprocessed to reflect any such code updates. 2. Fee Change Updates. Updates t,o the fee schedule shall become effective on the effective date of such fee schedule updates, as determined by the Payor ("Fee Change Effective Date"). However, the date of implementation of any fee schedule updates, i.e. the date beginning on which such fee change is used for reimbursement ("Fee Change ImFlementation Date") shall be the later of: (i) the date on whioh Payor is reasonably able to implement the update in the claims payment system; or (ii) the Fee Change Effective Date. Claims processed prior to the Fee Change Implementation Date shall not be reprocessod to reflect any updates to such lbe schedule, even if ssrvice was provided after the Code Change Effective Date, 3. Billins Requirements. Contracted Provider must bill HC?CS codes in addition to revenue code for services specified within this Exhibit. Failure to submit a HCPCS code may result in a claim denial. PPAWA-IfittitasCountyPublicHealth- 05.A7.2025 -ICMProviderAgrcernenl360268 Page I of 2