Laserfiche WebLink
Amendment to the Medical Group Participation Agreement <br />This amendment (this "Amendment') is to the Medical Group Participation Agreement, effective as <br />of 06/01/2026 (the "Agreement'), between UnitedHealthcare Insurance Company, <br />UnitedHealthcare of Washington, Inc., and UnitedHealthcare of Oregon, Inc. ("United") <br />contracting on behalf of each entity individually (collectively, "United") and Kittitas County ("Medical <br />Group"). <br />This Amendment is effective on 06/01/2026 (the "Amendment Effective Date"). <br />The parties agree to modify the Agreement as follows: <br />1. The capitalized terms used in this Amendment, but not otherwise defined, will have the meanings <br />ascribed to them in the Agreement. <br />2. Appendix 4 to the Agreement is deleted in its entirety and replaced with the Appendix 4 attached <br />hereto. <br />3. Medical Group represents that it has provided United with a Medical Group Professional Roster <br />that includes all of the following data elements for each Professional: Any previous Professional <br />Roster attached to the Agreement is deleted in its entirety. <br />- Name of Professional (first name, middle initial, last name) <br />- Degree (MD, DO, NP, PA, other) <br />- Gender(M/F) <br />- Provider Specialty(ies) (primary, secondary, additional specialties) <br />- Operates as and willing to be listed/assigned as a Primary Care Professional "PCP" (Y/N) <br />- State License Number <br />- Medicaid ID Number <br />- NPI Number <br />- Foreign Language(s) <br />- Admitting Hospital(s) <br />If any data element is not applicable to a specific Medical Group Professional, Medical Group will <br />indicate "not applicable" in the appropriate field. Acceptable formats include in writing, <br />electronically in Excel, ANSI, or text (comma delineated) formats. <br />4. The attached "Behavioral Health Services and Payment Addendum" is hereby added to the <br />Agreement as Attachment 1. <br />All other provisions of the Agreement shall remain in full force and effect. In the event of a conflict <br />between the terms of the Agreement and this Amendment, the Amendment will control. <br />Gen.slmd.SMGA.BH. Wd0615 - I - UniledHealtheare <br />Confidential and Proprietary <br />