Laserfiche WebLink
Docusign Envelope lD: CEBC6B3C-DFA1 -4BOC-AFE8-6A4A634400B0 <br />1.2 "Benefit Plan" means a healthcare benefit product defined by the applicable plan sponsor that <br />is offered or administered by CHPW for the payment of Covered Services provided to Members. <br />Each Benefit Plan is governed by one or more Benefit Plan Exhibits as indicated on Exhibit B. <br />1.3 "CHPW Health Benefit Exchange Product" (also referred to as "the CHPW Exchange <br />Product" or "CHPW HBE Product") means those health benefit programs offered and sold by <br />CHPW to individuals or groups who obtain health coverage through the Washinglon Health <br />Benefit Exchange. <br />l.4 "Clean Claim" means a reimbursement claim for provision of Covered Services submitted by <br />Facility to CF{PW that is (i) in the form required by CHPW, (ii) complies with the Health <br />lnsurance Portability and Accountability Act of 1996 ("HIPAA") and Administrative <br />Simplification for Electronic Data Interface, and (iii) has no defect or impropriety that may <br />prevent timely or accurate payment of the claim such as failure to include necessary <br />substantiating documentation, encounter data or documentation of particular circumstances <br />requiring special treatment. <br />l.5 "Copayments, Coinsurance and Deductibles" (also referred to as "Cost Sharing") are <br />payments a Member may be required to make to Facility in accordance with the conditions of the <br />Member's Benefit Plan. <br />1..6 "Covered Services" are the Medically Necessary health care services that are reimbursable <br />under a Member's Benefit Plan. <br />1.7 "Facility" means the party entering into this contract with CHPW and its Facility-Based <br />Providers. <br />1.8 "Facility-Based Providers" are duly licensed heath care providers that Facility contracts with <br />or employs, who provide Covered Services to Members at Facility locations and whose services <br />are billed under Facility's Tax ID Number(s) ("TfN"). <br />1.9 "Health Benefit Exchange" (also referred to as "the Exchange" or "IIBE") means the <br />Washington health benefit exchange established in RCW 43.7I.020, et seq., the Health Benefit <br />Exchange Act and regulated by the Washington State Office of the Insurance Commissioner <br />("oIC"). <br />l.l0 "Medically Necessary" means a service or supply which meets all of the following criteria: <br />1.10.1 is consistent with the symptoms or diagnosis and treatment of the Member's <br />condition; <br />L.I0.2 is the most appropriate supply or level of service that is essential to the Member's <br />needs and meets the recognized standards of medical care; <br />1.10.3 when applied to a Member inpatient, cannot be safely provided to the Member in a <br />less restrictive setting; <br />2020 Facility Agmt - Template Page 2 of51 Contract #5908-662684