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Child Care Provider Registration Agreement Page 15 8. You agree not to claim, and you will not be paid, more than the maximum number of units authorized for the billing month by ADES. 9. If a Client utilizes less than the maximum number of units authorized, you shall not claim, and ADES will not pay, for units not used. 10. Clients are responsible for payment of all additional charges. You shall not claim or be paid by the Department for additional charges. 11. Timeliness of Claims a. You agree to submit monthly claims for payment to ADES after the service month in which services are provided. b. ADES will not pay you for either original or supplemental billing claims received by ADES more than 180 days after the report date pre-printed on the billing form. 12. You agree not to claim reimbursement or charge Clients for services provided during any period in which the number of children in your facility exceeds the maximum number prescribed in provider/child ratio established by law. Failure to maintain provider/child ratio requirements shall constitute a material breach upon which ADES may immediately suspend new authorizations or terminate this Agreement under Section 6.0., Suspension of Authorizations, of this Agreement. 13. You agree not to claim reimbursement or charge Clients for services during any period in which your Provider license/certification is not in effect. Failure to maintain Provider license/certification shall constitute a material breach upon which ADES may immediately terminate this Agreement under Section 7.0, Termination of this Agreement. 14. You may not claim reimbursement from ADES for child care units when you know that the Client was not engaged in an ADES eligible activity. 15. Co-Payment Arrears a. In accordance with A.A.C. R6-5-4915, ADES may notify a Client with an unpaid Co-Payment two or more weeks in arrears that the Client is no longer eligible for child care assistance. In order for ADES to take this action, you must: i. Fax, scan or mail an Unpaid Co-Payment Worksheet (CCA-1021A) form to the Client’s Child Care Specialist; [see Attachment #12]; ii. Submit a current, completed and signed Provider/Parent/Guardian’s Agreement for Child Care Charges (CC-208) [see Attachment #8] form with the Unpaid Co-Payment Worksheet (CCA-1021A) [see Attachment #12], and, iii. Verify with the Client’s Child Care Specialist for each child for the period of time in question: (1) The amount of Co-Payment owed by the Client; (2) The total amount of any payments the Client has made on the outstanding Co- Payment balance; and, (3) The amount of additional charges owed by the Client. b. You agree that you shall not submit any portion of the outstanding Co-Payment balance that accrued more than 180 days prior to the date of ADES receipt of the Unpaid Co-Payment Worksheet (CCA-1021A) [see Attachment #12] in the unpaid Co-Payment process. CCA-1210B (4-16) – Arizona Department of Economic Security