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Docusign Envelope lD: 7 4E827C5-FAB8-8084-827C-41 4AD5992040 <br />IXHIBIT 1-A <br />Compensation Schcdule-Standard - Medicaid (Version 1) <br />Health Plan agrees to cornpensate Provider for Clean Claims for Covered Services rendered to Members, in <br />accordance with Health Plan's prograrns partioipation, on a fee-for-services basis, at the lesser of; (i) Provider's <br />billed charges, or (ii) the amounts set forth below, less any applicable Member co-payments, deductibles, co- <br />insurance, or amounts paid or to be paid by other liable third parties, if anyl <br />Covered Servic€s shall be paid at one hundred percent (100%) ofthe prevailing local and geographically adjusted <br />State of Washington Medicaid Fee-For-Service Program fee schedule in effect on the date of service. <br />If there is no payment rate in the State of Washington Medicaid Fee-For'-Service Program fee schedule as of the <br />date of service, payment shall be at one hundred perrcent (l00yo) of the prevailing Medicare Fee-For-Service <br />Program fee schedule, in effect on the date ofservice. <br />If there is no payment rate achieved in the above methodologies, reimbursement shall be paid at frfty percent <br />(50%) of billed charges. <br />MI-|WPROV.CS22.3 Comp Schcdule/$ apI 2024 Pagc I of I