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SHJ25-014 MOLINA HEALTHCARE INTERIM AGREEMENT- PARTIALLY EXECUTED
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2025-10-07 10:00 AM - Commissioners' Agenda
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SHJ25-014 MOLINA HEALTHCARE INTERIM AGREEMENT- PARTIALLY EXECUTED
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Last modified
10/2/2025 3:46:30 PM
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10/2/2025 3:45:18 PM
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Meeting
Date
10/7/2025
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve an Interim Agreement with Molina Healthcare for Re-Entry Initiative Services
Order
17
Placement
Consent Agenda
Row ID
136417
Type
Agreement
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i. Provider shall submit any dispute (other than a dispute relating to Claims Payment, which are <br />subject to Section 2.8 to Health Plan in writing within sixty (60) days of when the issue arises. <br />ii. Provider shall submit such disputes to the attention of Health Plan's Provider Services <br />Department. <br />b. Health Plan Response to Non -Claims Payment Related Disputes <br />i. Health Plan shall use best efforts to acknowledge by phone, e-mail or other writing, receipt of a <br />dispute (other than a dispute relating to Claims, which are subject to Section 2.8 within seven (7) <br />business days. <br />ii. Health Plan's decision regarding disputes shall be communicated within sixty (60) days of Health <br />Plan's receipt of Provider's written correspondence requesting review. If additional time is <br />required, Health Plan shall communicate this information to Provider within sixty (60) days. <br />iii. Health Plan shall use its best efforts to investigate and resolve disputes within sixty (60) days of <br />Health Plan's receipt of Provider's written correspondence. <br />c. Nonbinding Mediation. If Provider is dissatisfied with Health Plan's final resolution of a dispute or <br />if Health Plan fails to grant or reject Provider's request for review of a dispute within thirty (30) days <br />after it is received, Provider may submit the dispute to nonbinding mediation pursuant to RCW Title <br />7, Chapter 7.07. Nonbinding mediation shall not be utilized to adjudicate matters that primarily <br />involve review of Provider's professional competence or professional conduct and shall not be <br />available as a mechanism for appeal of any determinations made as to such matters. <br />d. Nonbinding Arbitration. Health Plan and Provider agree, as a condition precedent to the <br />commencement of any civil action in any court of competent jurisdiction, to submit to arbitration all <br />disputes arising from or related to this Agreement and the rendition of services to Members pursuant <br />to this Agreement which are not otherwise resolved pursuant to the processes set forth at Sections 2.8 <br />or 2.18; provided, however, that arbitration shall not be utilized to adjudicate matters that primarily <br />involve review of Provider's professional competence or professional conduct, and shall not be <br />available as a mechanism for appeal of any determinations made as to such matters. Arbitration shall <br />proceed according to the rules and regulations of JAMS Optional Arbitration Appeal Procedure, then <br />in effect, and shall be conducted in King County, Washington. The arbitrator shall have no authority <br />to award damages or provide a remedy that would not be available to such prevailing party in a court <br />of law. Nor shall the arbitrator have the authority to award punitive damages. The parties recognize <br />that the arbitrator's decision is not binding and that either party may seek judicial remedies following <br />the arbitration of a dispute. The panel of arbitrators shall be selected as follows: one arbitrator shall be <br />designated by Health Plan; one arbitrator shall be designated by Provider; and the third arbitrator shall <br />be selected by the arbitrators designated by Provider and Health Plan. Health Plan and Provider shall <br />divide and share equally the cost of the arbitrator. Each party shall be responsible for its own <br />attorneys' fees and costs. <br />NuMCBHSSCA.082025 Revised Aug 2025 (MHW) Page 7 of 12 <br />
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