My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
Asuris and KCPHD Agreement
>
Meetings
>
2018
>
06. June
>
2018-06-05 10:00 AM - Commissioners' Agenda
>
Asuris and KCPHD Agreement
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/31/2018 1:16:16 PM
Creation date
5/31/2018 1:14:19 PM
Metadata
Fields
Template:
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
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
48
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
status, age or sex. Medical Group will include the non-discrimination compliance <br />provision of this clause in all subcontracts entered into to fulfill its obligations under this <br />Agreement. <br />III. PAYMENT FOR MEDICAL SERVICES <br />3.1 PROVIDER COMPENSATION — Medical Group will be compensated for Medically <br />Necessary Covered Services provided to Members in accordance with the <br />compensation arrangements for the applicable Provider Network and the terms of <br />Members' Health Plans. The compensation arrangements for each Provider Network in <br />which Medical Group is a Participating Provider is set forth in exhibits and addenda <br />attached hereto and incorporated herein. The Medical Group agrees to accept the <br />compensation set forth in the payment exhibits as payment in full for Covered Services <br />provided to Members, whether that amount is paid in whole or in part by the Company, <br />the Member or by any combination of payers. The Company reserves the right to <br />establish and alter the payment methodology and levels from time to time with ninety (90) <br />days prior notice. Acceptance of reimbursement based on new payment levels or <br />methodology constitutes consent. <br />The Company shall pay claims as soon as practical, but subject to the following minimum <br />standards — (1) the Company shall pay 95% of the monthly volume of clean claims within <br />thirty (30) days of receipt by the Company; and (2) the Company shall pay or deny 95% <br />of the monthly volume of all claims within sixty (60) days of receipt by the Company. For <br />purposes of this Section 3.1, a "clean claim" means a claim that has no defect or <br />impropriety, including any lack of any required substantiating documentation, or particular <br />circumstances requiring special treatment that prevents timely payments from being <br />made on the claim under applicable Washington law. To the extent required by <br />Washington law, the Company shall pay simple interest at the rate of one (1 %) percent <br />per month on payable, clean claims not paid by the Company within sixty-one (61) days <br />of receipt. Such interest shall be calculated based on the amount to be paid to the <br />Medical Group for the Covered Services and shall be added to the Medical Group's <br />reimbursement without further claim submission from the Medical Group. Claims for <br />services provided to Members pursuant to a contract with, or on behalf of, the federal <br />government, including but not limited to the Federal Employees Health Benefits Program <br />(FEHBP), shall not be subject to interest set forth in this Section 3.1. <br />3.2 COMPENSATION FOR REFERRALS — Medical Group agrees not to accept any <br />compensation in return for referring any Member to a Medical Group for the furnishing of <br />any item or service payable by Company. Medical Group also agrees to refer Members <br />to providers in accordance with applicable state law and the laws and regulations of the <br />Medicare program. <br />3.3 MEMBER IDENTIFICATION — Medical Group will be responsible for establishing the <br />identity of all patients who present themselves as Members in any Health Plans and will <br />promptly report to Company any apparent abuse of the privileges of such Health Plans. <br />3.4 BILLING FOR PROVIDER SERVICES — Medical Group agrees to submit claims for <br />Covered Services electronically or as prescribed by Company or required by law. Claims <br />should be submitted within thirty (30) days of the date of services and, in any event, <br />shall be submitted no later than twelve (12) months from the date that Members receive <br />services. Claims not submitted within twelve (12) months of date of service shall be <br />disallowed and the Medical Group shall not bill the Member or Company for services <br />or supplies associated with such claims. The Medical Group shall not bill the <br />Company for more than the Medical Group's usual and customary fee for the services <br />rendered, nor shall the Medical Group bill services provided to Members at a rate <br />higher than the Medical Group bills services provided to persons without health care <br />coverage. The Medical Group agrees to abide by Company directives, whether <br />communicated by the Company through its Administrative Manual or other <br />communications and publications. <br />Asuris MGA Agreement (Rev. 05/2017) A18816854AA Page 5 of 20 <br />
The URL can be used to link to this page
Your browser does not support the video tag.