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sharing or other amormts, which have not otherwise been paid by a primary or secondary oarrier in accordance with regulatory standards for coordination of benefits, that are the Covered Pelson's financial responsibility under the applicable Coverage Agreement. 3 .5.2, Provider and each Contracted Provider agree, in the event of Payor's insolvency, to continue to provide ihe services promised in the Coverage Agreement to Covered Persons for the dwation of the period for which premiums on behalf of the Covered Persons were paicl to Company or Payor or until the Covered Personos discharge from inpatient facilities, whichever time is greater. 3.5,3. Notwithstanding any other provision of this Agreemenf nothing in this Agreem,ent shall be construed to modiff the rights and benefits contained in the Covered Person's Coverage Agreement. 3.5.4. Provider and each Contracted Providet may not bill Covered Persons for Covered Services (except for dedustibles, oopayme,lrts, or coinsurance) where Payor denies payment because Providen or a Contracted Provider has failed to comply with the terms or oonditions of this Agreement. 3.5,5, Provider and each Contraoted Provider further agree (i) that the provisions of 3,5.1, 3.5.2, 3.5.3,3.5.4 and 3.5,5 of this Section 3.5 shall survive termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of Covered Persons, and (ii) that these provisions supersede any otal or writte$ contrary agreement now existing or hereafter entered into between Contracted Provider and Covered Persons or persons acting on their behalf. 3.5.6. If Provider or Conhacted Provider contracts with other providers or facilities who agree to provide Covered Services to Covered Persons with the expectation of receiving payment directly or indirectly from Payor, such providers or facilities must agree to abide by the provisions of Subssctions 3,5,1 through 3,5.7. 3.5.7. Provider acknowledges that willfully collecting or attempting to colieot payment from a Covered Person, knowing that collection to be in violation of this Section 3.5,'constitutes a class C felony under RCW 48.80.030(5). 3,5.8. MentaVBehavioral l{ealth Providers.: I:r acoordance with RCW 4S.43.087 and RCW 48.43.087, nothing in this contract will prevent a mentaUbehavioral health practitioner and an enrollee from agreeing to have services provided at the Covered Persou's expilNe. If a mental/behavioral health practitioner provides serrices to an enrollee during an appeal or adverse certification process, the practitioner must provide firritten notification to the enrollee that payment for services is the enrollee's responsibilitS unless Health Plan ele,cts to pay. 3.6. Tenns and Conditions of Paliment. 3.6.1. Payor shall pay Provider and each Contracted Provider for Covered Services in accordance with the applicable Compensation Schedule as soon as practical but subject to lhe following minimum standards: (a) 95% of themonthlyvolumeof CleanClaims shallbepaid within30 days ofreceiptbyPayor;(b) 95% of themonttrly volume of all claims shall be paid or denied within 60 days of receipt by Payor, except as agreed to in writing by the Parties on a claim-by-claim basis. The date of receipt of a olaim is the date the Payor or its agent receives eilher written or electronic notice of the claim. Payor shall utilize a reasonable method for confirming receipt of claims and responding to Provider or Contracted Provider inquiries thereof. 3,6,2. Failure to pay claims within these minimum standards will result in interest payments on undenied and unpaid Clean Claims more than 61 days o1d until Payor meets the standards in this Section 3.6. Interest shall be assessed at the rate of LVo per month, and shall be caloulated monthly as simple interest prorated for any portion of a month, Payor shall add the interest payable to the amount of the unpaid claim without the necessity of the Provider or Contracted Provider submitting an additional claim. Any interest paid under this section shall not be applied by the Payor to a Covered Person's deductible, copayrnor! coinsurance, or any similar obligation of the Covered Person. PPA WA - I(ttitas Couniy Public Flealth - 05.07 .20?5 - ICMProvida'Agreernent 360268 Page 9 of 24