Laserfiche WebLink
Docusign Envelope lD: CEBC6B3C-DFA1 -4BOC-AFE8-6A4A63440086 <br />Exnrnn B-3-A <br />CHPW Hnnr,rH BnNnrrr ExcnlNcp <br />RnrvrsuRsrMENT Rarps <br />1. Rates. Subject to the terms and conditions of the Agreement, reimbursement rates for <br />Covered Services billed under Facility's tax ID number for the CHPW Health Benefit <br />Exchange Benefit Plans listed below shall be the lesser of billed charges or the following <br />and will be less any applicable Cost Sharing Amounts. <br />A.: <br />NetworkName: CHPW Cascade Care Affiliate Network <br />Inpatient Services: N/A% of Medicare Fee Schedule <br />for all Covered Services described therein; and <br />N/A% of the Washington State Health Care <br />Authority' s ("HCA's") Apple Health (Medicaid) <br />Fee Schedule for all Covered Services for which <br />no Medicare fee exists. <br />Outpatient Services:N/A% of Medicare Fee Schedule <br />for all Covered Services described therein; and <br />N/A% of the Washington State Health Care <br />Authority's ("HCA's") Apple Health (Medicaid) <br />Fee Schedule for all Covered Services for which <br />no Medicare fee exists. <br />Professional Services :N/A% of Medicare Fee Schedule <br />for all Covered Services described therein; and <br />N/A% of the Washington State Health Care <br />Authority' s ("HCA's") Apple Health (Medicaid) <br />Fee Schedule for all Covered Services for which <br />no Medicare fee exists. <br />2. Pavment. <br />A. CHPW will adjust payments to Facility consistent with adjustments that CMS and/or <br />HCA appliesto their respective fee schedule(s). 1 CHPW will pay, or require the <br />applicable third party plan sponsorto pay, Facility for Covered Services rendered to <br />Members in accordance withthe terms of this Agreement,the Provider Manual, the <br />applicable Benefit Plan, and billing instructions and policy guidelines published and <br />periodically updated by applicable state and federal agencies. <br />2021Facility Exh B3A - C[IPWHBERates Page 46 of51 Contract #5908-662684