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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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9.3.1 BINDING EXTERNAL REVIEW — For disputes that have exhausted the Provider <br />Billing Dispute and Medical Necessity/Investigational Procedure Appeal Process, <br />Medical Group may elect binding external review to resolve the disputed issue(s), <br />if certain conditions are met. In all cases if a dispute is submitted to external <br />review, the decision of the external reviewer is binding and the final decision on <br />the disputed issue. Disputes submitted to external review shall not be submitted <br />to mediation, arbitration or judicial remedy as provided herein. A description of <br />the external review process and any prerequisites to initiating the external review <br />process can be found in Exhibit D. Disputes that do not meet the criteria to be <br />submitted to binding external review may be submitted to binding external review <br />only upon mutual written agreement of the parties. <br />9.3.2 MANDATORY NON-BINDING MEDIATION — For disputes that have not been or <br />cannot be submitted to external review, the disputed issue(s) must be submitted <br />to mandatory non-binding mediation prior to seeking binding arbitration or <br />judicial remedy, except as otherwise provided herein. Mandatory non-binding <br />mediation must be requested within sixty (60) days following the date of the <br />Company's decision on Medical Group's last internal provider appeal. Where <br />Medical Group is allowed to bypass the internal provider appeal process as <br />provided herein, mandatory non-binding mediation must be requested within sixty <br />(60) days from the last day the Company has to timely respond to a dispute or a <br />request for a dispute. Medical Group and the Company shall each bear their <br />own costs of mediation and shall split equally the costs of the third -party <br />mediator. <br />9.3.3 JUDICIAL REMEDY & ARBITRATION — If, after exhausting the Company's <br />internal provider appeals process and completing mandatory non-binding <br />mediation, either party is still dissatisfied with the outcome and wants to further <br />dispute the issue(s), the disputing party shall elect to resolve the disputed <br />issue(s) through judicial remedy or binding arbitration. <br />9.3.3.1 JUDICIAL REMEDY — If, after completing any prerequisites to judicial <br />remedy as provided herein, the disputing party elects to resolve the <br />dispute through judicial remedy, the parties agree to comply with the <br />terms set forth in Section 10.7. <br />9.3.3.2 BINDING ARBITRATION — If, after completing any prerequisites to <br />binding arbitration as provided herein, the Medical Group elects to <br />resolve the dispute through final and binding arbitration, arbitration must <br />be initiated by making a written demand for arbitration on the Company. <br />The demand for arbitration must identify all issues on which the Medical <br />Group seeks arbitration, the contractual provisions on which the Medical <br />Group relies, the amount in dispute, and the relief requested. <br />The arbitration shall be conducted within one hundred and fifty (150) <br />miles of Medical Group's principal office address where notices under <br />the Agreement are sent, unless the parties mutually agree to conduct the <br />arbitration in a different location. The parties agree that the dispute shall <br />be submitted to one (1) arbitrator selected by mutual agreement of the <br />parties. If the parties cannot agree on an arbitrator, they shall obtain a list <br />of ten (10) possible arbitrators from a neutral source, such as the <br />American Arbitration Association, and shall strike arbitrators from the list <br />in turn, beginning with the party who won a coin toss, until only one <br />arbitrator remains. The remaining arbitrator shall hear the dispute, <br />unless either party shows such bias as would disqualify a judge from <br />hearing the proceeding, in which case the arbitrator shall be the next to <br />last name stricken. The parties shall share equally the fee of the <br />arbitrator, excluding the filing fee, if any, incurred in commencement of <br />the proceeding. The parties shall have the right to make substantive <br />Asuris MGA Agreement (Rev. 05/2017) Al8816854AA Page 16 of 20 <br />
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