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Docusign Envelope lD: CEBCOB3C-DFA1-4B6C-AFE8-6A4A634400B0 <br />B. Facility shall seek and accept payment from CHPW, or the applicable plan sponsor, <br />for Covered Services in accordance with the terms of this Agreement , the Provider <br />Manual, the applicable Benefit Plan, and billing instructions and policy guidelines <br />published and periodically updated by applicable state and federal agencies. Facility <br />shall have the right to bill, charge, or collect a deposit directly from a Member for <br />anyapplicable deductible, co-payment, or coinsurance, or for any services that is not <br />a Covered Service. In no event may Facility bill or collect form a Member any <br />difference between Facility's charges and the amount described in this Exhibit B-1- <br />Afor Covered Services. <br />Effective Date: 7 11 12025 <br />(CHPW/TO COMPLETE) <br />I Medicare Managed Care GME, IME, and Allied Health payments are paid through the Medicare cost reporting process, and are <br />therefore excluded from these referred payment rates. In addition, Sole Community Hospitals (SC[I) and Medicare Dependent <br />Hospitals (MDII) receive a supplemental payment if their inflated and case mix adjusted base-year cost, referred to as their <br />Hospital Specific Rate (HSR) exceed the Medicare Operating MSDRG and Outlier payments under traditional Medicare Part A <br />fee for service. SCH and MDH special payment adjustrnents are excluded from these referred payment rates. <br />2021 Facility Exh B3A- CHPWHBERates Page 47 of51 Contract #5908-662684