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Docusign Envelope lD: 7 4E827C5-FAB8-8084-827C-41 4AD59920A0 10. neoessity, medical appropriateness, or otherwise covered by the patient's seryice agreement with Health Plan. Health Plan will not prohibit, discourage, or penalize Provider if otherwise practicing in compliance withthe law from advocating on behalf of a Member with Health Plan. Members are free to contract at any time to oblain any health care services outside their Health Plan on any terms or conditions the Menrbers ohoose. Nothing in this section shall be construed to authorize Provider to bind Health Plan to pay for any service. Health Plan does not preclude or discourage Member or those paying for their covetage from discussing the comparative merits of different health camiers with Provider. This prohibition specifically includes prohibiting or limiting Providers participating in those discussions evon if ct'itical of a Health Plan. Plovider will make health records available to appropriate state ancl federal authorities involved in assessing the quality of care or investigating complaints, gtievances, appeals or review of any adverse benefit determinations of Members subject to applicable state and federal laws related to the confidentiality of medical or health records. Provider is required to cooperate with audit reviews of oncounter dalain relatlon to the administration of Health Plan risk adjustment and reinsurance programs. Provider shall furnish Covered Services to Members without regard to the Members enrollment in Health Plan as a private purchaser ofthe plan or as a participant in publicly flnanced programs ofhealth care seryices. This requirement does not apply to circumstances when Provider should not render services clue to limitations arising from lack of training, experience, skill, or licensing restrictions. Provider rnay, in good faith, report to state or federal authorities any act or practice by Health Plan that jeopardizes Member health or weltare or that may violate state or federal law. Terms and Conditions of Payment a. For Covered Services provided to Members, Health Plan shall pay Provider, and Provider shall pay any of its subcontractors, as soon as practical but subject to the following minimum standards including any applicable federal regulations (i.e.42 CFR 422.520(b)): i. Ninety-five (95%) percent of the monthly volume of Clean Claims shall be paid within thirty (30) days of receipt by Health Plan or Health Plan's agentl ii. Ninety-five percent (9570) of the monthly volume of all Claims shall be paid or denied within sixty (60) days of receipt by Health Plan or Health Plan's agent; iii. Nine ty-nine percent (99%) of the monthly volume of Clean Claims shall be paid within ninety (90) calendar days of receipt, except as agreed to in writing by the parties on a Claim-by-Claim basis. b. A Claim is a bili for services, a line item of service or all services for one Member within a bill. c. The date of receipt of a Claim is the date Health Plan or Health Plan's agent reoeives either written or electronic notice of the Claim. d. The date of payment is the date of the check or other form of payment. e. Health Plan shall establish a reasonable method for confirming receipt of Claims anrl responding to Provider inquities about Claims. f. For those State products/programs covered by the Washington Administrative Code (WAC), failure of Flealth PIan to abide by the tirnely Claims payment standards delineated in WAC 284-170-431Q) shall result in a requirement to pay interest on undenied and unpaid Clean Claims more than sixty-one days old until Health PIan meets the standards under that subsection. Interest shall be assessed at the rate of one percent per month and shall be calculated monthly as simple interest prorated for any portion of a month, I-Iealth Plan shall add the interest payable to the amount of the unpaid claim without the necessity of Provider submitting an additional claim, g, When Health Plan issues payment in Provider's name and the Member's name, Health Plan shall make Claim checks payable in the name of the Provider first and the Member second. 1l 12. 13, 14, MFIWPROV22.3 MIMPSA,/Rev is ed J an 2024 Page l9 of25