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Docusign Envelope tD: CEBC6B3C-DFA1-4BOC-AFE8-6A4A634400B0 <br />4.4.2Faciliby shall promptly notify CHPW if it becomes aware that a Member has a <br />subrogation claim or right to reimbursement from a third party and assist CHPW in arranging <br />for assignment of such right to CHPW for collection. Facility shall also notiff CHPW of <br />Members that may approach stop-loss deductibles, have other insurance coverage available, <br />or be eligible for Social Security coverage. <br />4.4.3 Except as otherwise required by Chapter 284-51WAC, under no circumstances shall <br />CHPW reimburse Facility any amount greater than that provided for hereunder. If Facility <br />has received payment from another coverage plan or entity that has primary payment <br />responsibility under coordination of benefits rules, and that payment is equal to or greater <br />than the rates set forth herein, Facility may not seek additional reimbursement from CHPW. <br />In addition, Facility agrees to promptly refund to CHPW any amount CHPW has already <br />paid to Facility which, when added to amounts paid by another coverage plan or entity for <br />the same Covered Services, are in excess of the rates set forth in this Agreement. <br />4.5 Retrospective Review and Recovery Rights. <br />4.5. 1 CHPW reseryes the right to assure through audit and retrospective evaluation of a <br />Member's documented medical care that, based on the information available to the affending <br />physician or order provider at the time services were provided, services provided were <br />Medically Necessary and claims were accurately coded. Such review or audit may result in <br />denial of claims for services on the basis of Medical Necessity or effors in claims submission <br />and may adversely impact payment. <br />4.5.1.1 CHPW may retrospectively deny a claim (a) if it is determined that prior <br />authorization was based upon a material misrepresentation by Facility or a Facility-Based <br />Provider, and/or (b) if information provided to CHPW is materially different from <br />information that was reasonably available at the time of the original determination. <br />4.5.2 Any payments made to Facility by CHPW that are determined to be inappropriate in <br />accordance with applicable law, or to which Facility is not entitled under the terms of this <br />Agreement or the Provider Manual, shall be considered an ove{payment. Overpayments <br />shall be refunded to CFIPW within thirty (30) days of the date Facility is notified of the <br />overpayment or within sixty (60) days of identification of an overpayment by Facility, <br />whichever is earlier. Alternatively, CHPW may, in its discretion, immediately offset or <br />recoup any and all overpayments or other amounts owed by Facility to CHPW against <br />amounts owed by CHPW to Facility. <br />4.5.3 Facility agrees that all recoupment and any offset rights under this Agreement will <br />constitute rights of recoupment authorized under State or federal law and that such rights will <br />not be subject to any requirement ofprior or other approval from any court or other <br />government authority that may now have or hereafter have jurisdiction over Facility. <br />Notwithstanding the foregoing, except in the case of fraud, CHPW may not request (a) a <br />refund of a payment previously made to satisflz a claim unless CHPW does so in writing <br />within twenty-four (24) months (or within thirty (30) months for reasons related to <br />coordination of benefits) in accordance with RCW 48.43.600 or (b) payment of a contested <br />2020 Facility Agmt- Template Page 14 of51 Contract #5908-662684