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Docusign Envelope lD: C1 90C649-709E-4E00-A409-4Al 6CED8C800 <br />4.1.1 . Fifty percent (50%) of funds is received from the United States Department of <br />Heidn and Human Services under MedicalAssistance Program CFDA 93.778; <br />and <br />4.1.2. Fifty percent (50%) is received from the Contractor's Local Matching Funds. <br />4.2. Source of funds for Administrative Claiming for appropriately documented Skilled Professional <br />Medical personnel and appropriately documented lnterpreter staff Administrative Claiming are <br />as follows: <br />4.3 <br />4.4 <br />Washington State <br />Health Care AuthoritY <br />4.2.1. Seventy-five percent (75%) of funds is received from the United States <br />Department of Health and Human Services under MedicalAssistance Program <br />CFDA 93.778; and <br />4.2.2. Twenty-five percent (25%) is received from the contractods local matching funds- <br />Local matching funds must meet CPE requirements and must be in the Contractor's budget <br />and under the Contractor's control. These funds cannot be contributed by or certifled by <br />healthcare providers or subcontractors. <br />HCA will not issue reimbursement for any quarters where HCA receives credible evidence or <br />suspected evidence of a system failure that has the potential to impact the integri$ of the <br />reimbursement request. This inctudes but is not limited to failures related to the time study, <br />MER calculation, claim calculation, or reconciliation. <br />4.4.1. HCA will pursue corrective action as needed and will restore payment after any <br />issues reiated to the reimbursement request are resolved, and the requested <br />amount is accurate. <br />5. BILLING PROCEDURE <br />5.1. Contractor must submit accurate invoices to the HCA Contract Manager for all amounts to be <br />paid by HCA via e.mail to the HCA Contract Manager email address listed on the cover of this <br />Agreement. lnclude the HCA Contract number in the subject line of the email. <br />s.Z. All invoices will be reviewed and must be approved by the Contract Manager or designee prior <br />to payment. <br />S.3. Contractor shall only submit invoices for Services or deliverables as permitted by this section <br />of the Contract. The Contractor shall not bill HcA for Services performed under this Contract, <br />and HCA shall not pay the Contractor, if the Contractor is entitled to payment or has been or <br />will be paid by any other source, including grants, for such Services or deliverables. <br />5.4. Contractor must submit properly itemized invoices to include the following information, as <br />applicable: <br />5.4.1. The HCA Contract number; <br />HCA iAA K8630 <br />Revised 0712023 <br />Page l0 of35