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Docusign Envelope lD: C1 90C649-709E-4E00-A409-4A"1 6CED8C800 4.9 4.8.4. The invoice must report a Summary for each lnterpretation Service contract including the names of the interpreting staff, the total amount of time spent performing allowable MAC activities, and total dollar amount claimed for reimbursement. 4.g.5. The Contractor is prohibited from altering the information on the patient encounter forms and certifies the accuracy of the data entered into the spreadsheet and the system by signing the 419 by an Authorized RePresentative. Calculation and Application of the Pertinent MER 4.g.1. All MERs must be calculated quarterly and match the methodology outlined in the contractor's annual MER proposal' 4.9.2. All MERs must be based on the quarter claimed 4.9.3 4.9.4 4.9.5. Washington State Health Care Authority 4.9.6. 4.1O. Demographic Data Requirements for the Client MER: 4.10.1. All data related to Medicaid enrollment and the MER must be maintained according to the SOS records retention schedule. 4.10.2.The information collected must be sufficiently detailed to determine Medicaid enrollment through HCA's ProviderOne System. 4.10.3 The information must be entered in the Contractor's Client information System or database. All MAC activities that benefit the Contractors Clients directly and are performed within a program that identifies clients may use a client- based MER as described in the CAP and Manual. All MAC activities that benefit the Contractor's Clients directly and are performed within a program that operates a primary care or specialty clinic may use a clinic-based MER as described in the CAP and Manual. All MAC activities that benefit a larger population in the geographical region served by the contractor, or in programs that do not identify Clients or collect demographic data may use the modified county-wide MER. The Contractor is required to collect and maintain demographic data used to determine Medicaid enrollment for all Clients served within budget units whose costs are included in the FFP reimbursement. The Contractor is prohibited from including clients from any budget unit that is not allowable within the MAC program. HCA Contract #K8630 Attachment 5 26