Common use of Billing for Services Clause in Contracts

Billing for Services. Specialty Care (if applicable): a. The Agency shall submit a completed Health Insurance Claim Form 1500 (hereinafter referred to as “HICF”) for all Services rendered during the prior month. b. The HICF form shall be completed in its entirety and shall provide a sufficient description of the Services rendered in order to verify payment (e.g. Client name, unique identifier, County of residency, Services provided, including applicable CPT code, and a charge reflecting the negotiated rate). Any HICF form that is incomplete or which fails to provide the necessary supporting documentation shall be deemed incomplete and rejected. c. The Agency agrees to actively pursue and bill any third-party coverage for available contribution toward the cost of Services incurred by the Client. d. The Agency agrees to reimburse the Recipient any monies that may have been received from any third-party coverage, after payment has been made by the Recipient. Reimbursements shall be any amounts received up to the amount paid by the Recipient. The Agency shall report to the Recipient any payment received from, or any pending claims with, any third-party when submitting requests for reimbursement to the Recipient. e. All completed HICF forms shall be submitted to the Recipient for review and approval no later than the tenth (10th) business day of each month and shall include all supporting documentation necessary for processing. HICF forms received after the fourth (4th) business day of each month shall be deemed as late and may result in delayed, reduced, or denial of payment, in the sole discretion of the Recipient. f. All HICF forms for tests, procedures, and Services that are not listed on the Medicare Part B Fee Schedule will be made at a rate not to exceed 150% of the Medicare Part B Fee Schedule unless otherwise pre- approved in writing through a Recipient waiver. g. For all invoices or requests for payment relating to specialty medical care, the Agency shall provide a copy of the associated authorization form for such Services.

Billing for Services. Specialty Care (if applicable): a. The Agency shall submit a completed Health Insurance Claim Form 1500 (hereinafter referred to as “HICF”) for all Services rendered during the prior month. b. The HICF form shall be completed in its entirety and shall provide a sufficient description of the Services rendered in order to verify payment (e.g. Client name, unique identifier, County of residency, Services provided, including applicable CPT code, and a charge reflecting the negotiated rate). Any HICF form that is incomplete or which fails to provide the necessary supporting documentation shall be deemed incomplete and rejected. c. The Agency agrees to actively pursue and bill ▇▇▇▇ any third-party coverage for available contribution toward the cost of Services incurred by the Client. d. The Agency agrees to reimburse the Recipient any monies that may have been received from any third-party coverage, after payment has been made by the Recipient. Reimbursements shall be any amounts received up to the amount paid by the Recipient. The Agency shall report to the Recipient any payment received from, or any pending claims with, any third-party when submitting requests for reimbursement to the Recipient. e. All completed HICF forms shall be submitted to the Recipient for review and approval no later than the tenth (10th) business day of each month and shall include all supporting documentation necessary for processing. HICF forms received after the fourth (4th) business day of each month shall be deemed as late and may result in delayed, reduced, or denial of payment, in the sole discretion of the Recipient. f. All HICF forms for tests, procedures, and Services that are not listed on the Medicare Part B Fee Schedule will be made at a rate not to exceed 150% of the Medicare Part B Fee Schedule unless otherwise pre- approved in writing through a Recipient waiver. g. For all invoices or requests for payment relating to specialty medical care, the Agency shall provide a copy of the associated authorization form for such Services.