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Docusign Envelope lD: CEBC6B3C-DFA1 -486C-AFE8-6A4A63440080 <br />outside a CHPW Benefit Plan on any tenns or conditions a Member chooses. Nothing herein <br />shall be construed to bind CHPW to pay for services delivered outside a CHPW Benefit Plan <br />IV. BILLING AND REIMBURSEMENT <br />4.L For all billing and reimbursement activities, the parties shall comply with applicable billing <br />instructions, practices and policy guidelines herein and as published and periodically updated in <br />the Provider Manual and, as applicable, by HCA and CMS instructions and coverage/non- <br />coverage determinations. If there is a conflict between the substance or interpretation of the HCA <br />Billing Instructions applicable to the fee-for-service Medicaid program and the Provider Manual, <br />the Provider Manual shall control. If there is a conflict between the substance or interpretation of <br />CMS instructions or determinations on coverage and the Provider Manual, the CMS instructions <br />or determinations shall control. <br />4.2 Claims and Encounter Submission. <br />4.2.l Facility shall comply with the claims, encounter reporting, payment, and billing <br />procedures set forth inthe Provider Manual and submit Clean Claims for Covered Services <br />rendered to the address set forth on the Member's identification card in nationally approved <br />standard formats and through a CHPW approved clearinghouse. Without limiting the <br />generality of the foregoing, encounters shall be submitted within thirry (30) days of the end <br />of the month in which the service was rendered. Except as otherwise stated, Facility shall <br />use best efforts to submit claims/encounters electronically. <br />4.2.2IJponrequest, Facility shall furnish all information reasonably required by CHPW to <br />substantiate the provision of and charges for Covered Services, at no charge to CHPW. <br />Claim approval and payment for claims or encounters are contingent upon receipt of <br />complete and accurate information from Facility. <br />4.2.3 To the extent that Facility is billing for pharmacy claims, Facility shall be subject to the <br />Provider Manual terms with regard to prior authorization procedures including policies <br />regarding emergency fill authorizations. <br />4.3 Reimbursement. <br />4.3.1 CHPW shall reimburse Facility for timely submitted Clean Claims for Covered <br />Services it provides to Members in accordance with this Section IV and the applicable <br />Benefit Plan Exhibit(s) in Exhibit B. Facility shall accept such reimbursement plus any <br />applicable Cost Sharing amounts as payment in full for Covered Services rendered by <br />Facility and Facility-Based Providers. <br />4.3.2 CHPW shall not pay a claim received (i) more than three hundred and sixty-five (365) <br />calendar days after the date a Covered Service was rendered or the date of discharge, <br />whichever is later or (ii) more than sixty (60) calendar days after Facility first receives notice <br />that CHPW is a secondary payer under applicable coordination of benefit procedures. <br />2020 Facility Agmt - Template Page 12 of51 Contract #5908-662684