Washington State Healthcare Authority 3/22/2019

HCA Special Terms and Conditions under its administrative control, or certified by the contributing government agency as expenditures eligible for FFP. Required local matching funds and certified expenditures must be at the government agency level. (2) The Contractor shall cooperate in supplying any information to HCA that may be needed to verify accuracy of reimbursable billings. (3) The Contractor shall not use funds payable under this Agreement as local match toward federal funds. (4) The Contractor shall use these funds to supplement, not supplant the amount of federal, state and local funds otherwise expended or services provided under this Agreement. (5) The Contractor shall not use funds payable under this Agreement for lobbying activities of any nature. The Contractor certifies that no state or federal funds payable under this Agreement shall be paid to any person or organization to influence, or attempt to influence, either directly or indirectly, an officer or employee of a state or federal agency, or an officer or member of any state or federal legislative body or committee, regarding the award, amendment, modification, extension, or renewal of a state or federal contract or grant. (6) The Contractor shall not pay Consultants and/or Billing Agents, or Subcontractors on either a contingent, or percentage basis, for work performed as a result of this Agreement. 6. Billing and Payment a. Contractor shall submit claims under this Agreement in accordance with Ambulance Transportation Provider Guide. b. The Guide can also be accessed at: http://hca.wa.gov/billers-providers/claims-and-billing/professional-rates-and-billinq-quides c. Contractor shall submit the required local matching funds within one hundred twenty (120) days from the date HCA fiscal staff submits the local match invoice to the GEMT provider. If the local match is not received within one hundred twenty (120) days, the provider will not receive the GEMT supplemental payment. d. Contractor shall submit all initial claims no later than three hundred sixty five (365) days from the date of GEMT service(s). Contractor is encouraged to submit claims as quickly as possible. (See WAC 182-502-0150). e. If the Contractor chooses to appeal a claim that was denied, or has questions regarding a Remittance Advice or Medicaid eligibility, they must contact Medicaid Customer Services for assistance at 1-800- 562-3022. f. The Contractor will not share or disclose their ProviderOne access information (i.e. user name, domain, and password) with anyone other than authorized GEMT personnel. If a disclosure of ProviderOne access information does occur, the Contractor must contact ProviderOne Security at 1- 800-562-3022 to have their access privileges reset. State of Washington Page 3 of 19 Contract No.K2850 Health Care Authority