Asuris and KCPHD Agreement - Laserfiche WebLink

Home Browse Search

Claims for which the Company is the secondary insurer must be submitted within thirty (30) days of the primary carrier's payment or denial. The Medical Group agrees to submit claims using the most appropriate, current and specific coding when billing for services rendered. The Medical Group agrees that it will not engage in misleading billing practices or otherwise interfere with timely and accurate claims adjudication. Except for infrequent and isolated waivers for charitable purposes, the Medical Group shall charge to and make reasonable attempts to collect from the Member all coinsurance amounts owed by the Member, after receiving a claims adjudication determination by the Company, and may collect all deductibles and copayments at the time of service. Because of the difficulty of ascertaining damages resulting from breach of this provision, the parties agree that the Company shall be entitled to deny all or part of claims as liquidated damages if the Medical Group fails to make a reasonable attempt, using such steps as normally taken to collect Deductibles, coinsurance or Copayments. In no event shall the Medical Group charge to a Member for Deductibles, coinsurance or Copayments exceed the amounts established by the Company. As required by WAC 284-43-320(3) the Company hereby informs the Medical Group that willfully collecting or attempting to collect an amount knowing that the collection is in violation of this Agreement constitutes a class C felony under RCW 48.80.030(5). In no event shall the Medical Group seek additional reimbursement for Covered Services delivered to Members, except for any copayments, deductibles or coinsurance amounts that the Member may owe, as determined by the Company. 3.5 MEMBERS TO BE HELD HARMLESS 3.5.1 The Medical Group hereby agrees that in no event, including, but not limited to, nonpayment by the Company, Company's insolvency or breach of this Agreement, shall the Medical Group bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against Member or person, other than the Company, acting on their behalf, for services provided pursuant to this Agreement. This provision shall not prohibit collection of Deductibles, Copayments, Co -Insurance, and/or non -Covered Services, which have not otherwise been paid by a primary or secondary carrier in accordance with regulatory standards for Coordination of Benefits, from covered persons in accordance with the terms of the Member's Health Plan. 3.5.2 The Medical Group agrees, in the event of the Company's insolvency, to continue to provide the services promised in this Agreement to Members for the duration of the period for which premiums were paid to the Company on the Members' behalf, or until the Members' discharge from inpatient facilities, whichever time is greater. 3.5.3 Notwithstanding any other provision of this Agreement, nothing in this Agreement shall be construed to modify the rights and benefits contained in the Member's Health Plan. 3.5.4 The Medical Group may not bill Members for Covered Services (except for Deductibles, Copayments or Co -Insurance) where the Company denies payments because the Medical Group has failed to comply with the terms of this Agreement. 3.5.5 The Medical Group further agrees (i) that the above provisions 3.5.1, 3.5.2, 3.5.3, and 3.5.4 shall survive termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of the Company's Members, and (ii) that this provision supersedes any oral or written contrary agreement between the Medical Group and Members or persons acting on their behalf. Asuris MGA Agreement (Rev. 05/2017) Al8816854AA Page 6 of 20