SHJ25-014 MOLINA HEALTHCARE RENEWAL - PARTIALLY EXECUTED

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iii. Notwithstanding any other provision of this Agreement, nothing in this Agreement shall be construed to modify the rights and benefits contained in the Member's Health Plan. iv. Provider may not bill the Member for Covered Services except for deductibles, copayments, or coinsurance where Health Plan denies payments because Provider has failed to comply with the terns of this Agreement. v. Provider further agrees i) that the provisions of paragraphs i, ii, iii, iv of this section shall survive termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of Health Plan's Members; and ii) that this provision supersedes any oral or written contrary agreement not existing or hereafter entered into between Provider and Member or persons acting on their behalf. vi. If Provider contracts with other providers or facilities who agree to provide Covered Services to Members of Health Plan with expectation of receiving payment directly or indirectly from Health Plan, such providers or facilities must agree to abide by paragraphs i, ii, iii, iv, v, of this section. e. Coordination of Benefits. Health Plan is a secondary payer in any situation where there is another payer as primary carrier. Provider shall make reasonable inquiry of Members to learn whether Member has health insurance or health benefits other than from Health Plan or is entitled to payment by a third party under any other insurance or plan of any type, and Provider shall immediately notify Health Plan of said entitlement. In the event that coordination of benefits occurs, Provider shall be compensated in an amount equal to the allowable Clean Claim less the amount paid by other health plans, insurance carriers and payers, not to exceed the amount specified in Exhibit 1 and its applicable sub -exhibits. f. Offset. In the event that Health Plan determines that a Claim has been overpaid or paid in duplicate, or that funds were paid which were not provided for under this Agreement, Health Plan may make a written request for repayment: (1) within twenty-four (24) months after the date that the payment was made; (2) within thirty (30) months after the date that the payment was made if the request is related to coordination of benefits with another carrier or entity responsible for payment of the Claim; or (3) at any time if a third party is found responsible for satisfaction of the Claim as a consequence of liability imposed by law and Health Plan is unable to recover directly from the third party because the third party has either already paid or will pay Provider the health care services covered by the Claim. Provider may contest Health Plan's request in writing by participating in the Claims dispute process as outlined in Section 2.8g. Overpayment and duplicate payment disputes must be submitted in writing within thirty (30) days of receipt of request. If it is decided that Health Plan will recover the contested payment, such refund may be recovered by way of offset or recoupment from current or future amounts due Provider after six (6) months have passed from the date Health Plan received Provider's written notice contesting the repayment. In addition to any other contractual or legal remedy, if Provider fails to contest Health Plan's request for a refund in writing within thirty (30) days of receipt of the request or if Provider contested the request and six (6) months has passed from the date Provider received Health Plan's refund request, Health Plan may recover the amounts owed by way of offset or recoupment from current or future amounts due Provider. As a material condition to Health Plan's obligations under this Agreement, Provider agrees that the offset and recoupment rights set forth herein shall be deemed to be and to constitute rights of offset and recoupment authorized in state and federal law or in equity to the maximum extent legally permissible, and that such rights shall not be subject to any requirement of prior or other approval from any court or other governmental authority that may now or hereafter have jurisdiction over Health Plan and/or Provider. Nothing in this section prohibits Provider from choosing at any time to refund to Health Plan any payment previously made by Health Plan to satisfy a Claim either by way of repayment by Provider or a request that Health Plan offset or recoup the money from current or future amounts due Provider. g. Claims Dispute Process. In the event that Provider determines that a Claim has been improperly denied or underpaid, Provider may make a written request for payment: (1) within twenty-four (24) months after the date the Claim was denied or payment intended to satisfy the Claim was made; (2) within thirty (30) months after the date the Claim was denied or payment intended to satisfy the MHWPROV22.3 MHWPSA/2evised Jan 2024 Page 10 of 25