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Asuris and KCPHD Agreement
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2018-06-05 10:00 AM - Commissioners' Agenda
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Asuris and KCPHD Agreement
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Last modified
5/31/2018 1:16:16 PM
Creation date
5/31/2018 1:14:19 PM
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Meeting
Date
6/5/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
k
Item
Request to Approve an Agreement between Asuris Northwest Health and the Kittitas County Public Health Department
Order
11
Placement
Consent Agenda
Row ID
45299
Type
Agreement
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VIII. AMENDMENTS <br />8.1 The Agreement; any addenda, attachments, fee schedules or exhibits thereto; any <br />policies or procedures incorporated into the Agreement by reference; the provider <br />administrative manual; and medical and reimbursement policies may be amended by <br />the Company by giving ninety (90) days prior written notice to the Medical Group of <br />such amendment(s). If the Medical Group objects to the amendment, the Medical Group <br />may terminate this Agreement by giving the Company written notice no later than thirty <br />(30) days after receipt of the written notice of the amendment. Said termination will be <br />effective at the end of the ninety (90) day notice period, unless within sixty-five (65) <br />days of the date of the notice of amendment, the Company gives the Medical Group <br />written notice that the Company will not implement the amendment. <br />In the event state or federal laws are enacted, or state or federal regulations are <br />promulgated, which Company determines renders this Agreement, or any provision, <br />illegal or this Agreement is otherwise deemed by a state or federal regulatory agency <br />to violate such laws or regulations, this Agreement shall be immediately reformed to <br />comply with such laws or regulations or terminated. Amendments required because of <br />legislative, regulatory or legal requirements do not require the consent of the Medical <br />Group and will be effective immediately upon notice to the Medical Group of the effective <br />date thereof. Company will, as promptly as possible, provide notice to the Medical Group <br />of such amendments. <br />IX. DISPUTE RESOLUTION <br />9.1 MEMBER COMPLAINTS — Medical Group agrees to cooperate fully with the Company in <br />the investigation and resolution of Member complaints and grievances concerning <br />Covered Services provided under this Agreement. Upon request, Medical Group will <br />furnish the Company with a copy of its procedures for handling Member complaints. <br />9.2 INTERNAL PROVIDER APPEAL PROCESSES — Company shall maintain one or more <br />internal provider appeal processes to adjudicate disputes that may arise between Medical <br />Group and the Company. The Company's internal provider appeal processes are set <br />forth in Exhibit D to this Agreement and incorporated herein by reference. Unless <br />otherwise indicated herein or in Exhibit D, Medical Group must exhaust the applicable <br />provider appeals process before initiating any of the post -appeal processes set forth <br />below. <br />In the event the Company rejects a Medical Group's request to dispute an issue, or fails <br />to notify Medical Group that Medical Group's request to dispute an issue has been <br />accepted, within thirty (30) days from the date the request is made, Medical Group may <br />bypass the applicable provider appeals process and proceed directly to mandatory non- <br />binding mediation, which shall be conducted in accordance with RCW chapter 7.07. <br />Medical Group and Company shall each bear their own costs of mediation and shall split <br />equally the costs of the third -party mediator. <br />In addition, if Medical Group submits a dispute to the Provider Billing Dispute Appeal <br />Process, and the Company fails to timely render a decision based on the time frames <br />described in Exhibit D, Medical Group may bypass the Provider Billing Dispute Appeal <br />Process and proceed directly to one or more of the post -appeal processes described <br />below. <br />9.3 POST -APPEAL PROCESSES — If, after the exhaustion of the applicable internal provider <br />appeals process, either party is dissatisfied with the outcome of the internal provider <br />appeal and wants to further dispute the issue(s), the disputed issue(s) must be submitted <br />to one or more of the processes as described below. Any prerequisites to initiating one <br />of the processes described below must be met before the process can be initiated. <br />Alternative dispute resolution, unless so elected by the Medical Group as provided <br />herein, is not required to the exclusion of judicial remedies. <br />Asuris MGA Agreement (Rev. 05/2017) A18816854AA Page 15 of 20 <br />
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