Common use of Contractor Payments Clause in Contracts

Contractor Payments. Administration 26 1. For fiscal intermediary services provided by CONTRACTOR in accordance with the 27 Agreement, COUNTY shall, upon receipt of an appropriate invoice, pay CONTRACTOR monthly, in 28 arrears, as follows; provided however the total for each Period shall not exceed COUNTY’s Maximum 29 Obligation to INTEMEDIARY for each Period as specified in the Referenced Contract Provisions of the 30 Agreement: 31 a. Period One – $2.50 per Claim received by CONTRACTOR from Physicians during the 32 period between and including July 1, 2016 through June 30, 2017 for Emergency Services and/or Care 33 provided within one year of the Claim being submitted; 34 b. Period Two - $2.50 per Claim received by CONTRACTOR from Physicians during the 35 period between and including July 1, 2017 through June 30, 2018 for Emergency Services and/or Care 36 provided within one year of the Claim being submitted ; and 37 // 1 c. Period Three - $2.50 per Claim received by CONTRACTOR from Physicians during 2 the period between and including July 1, 2018 through June 30, 2019 for Emergency Services and/or 3 Care provided within one year of the Claim being submitted. 4 d. CONTRACTOR and ADMINISTRATOR agree to a discounted group rate of $2.00 per 5 claim if a group, consisting of four programs exists: 1) Medical Safety Net Program, 2) Emergency 6 Medical Services Fund Program, 3) Public Health Services Program, and 4) Correctional Health 8 e. The parties agree that Claims for Emergency Medical Services and/or Care for each 9 Period may be received by CONTRACTOR up to three (3) months following the end of each Period and 10 that CONTRACTOR shall be reimbursed by COUNTY for said claims upon submission of an 11 appropriate invoice to ADMINISTRATOR. 12 f. For the purposes of reimbursement to CONTRACTOR, a Claim shall be reimbursed 13 regardless of the adjudication result, including but not limited to Claims that are paid, denied, 14 duplicates, and resubmitted. 15 2. Upon approval of ADMINISTRATOR, CONTRACTOR may use a portion of any interest 16 earned by the Funds or Recovery Funds to offset actual cost of postage associated with any mailings, 17 except check and Explanation of Benefit (EOB) mailings, required in accordance with the Agreement. 18 Contractor shall report to County the amount of interest charged against postage. CONTRACTOR shall 19 use any remaining interest to reimburse claims in accordance with the Agreement.

Contractor Payments. Administration 26 9 1. For fiscal intermediary services provided by CONTRACTOR in accordance with the 27 Agreement10 Contract, COUNTY shall, upon receipt of an appropriate invoice, pay CONTRACTOR monthly, in 28 11 arrears, as follows; provided however the total for each Period shall not exceed COUNTY’s Maximum 29 Obligation Amount 12 Not to Exceed to INTEMEDIARY for each Period as specified in the Referenced Contract Provisions of 13 the 30 AgreementContract: 31 14 a. Period One – $2.50 3.25 per Claim received by CONTRACTOR from Physicians during the 32 15 period between and including July 1, 2016 2024 through June 30, 2017 2025 for Emergency Services and/or Care 33 16 provided within one year of the Claim being submitted; 34 17 b. Period Two - $2.50 3.40 per Claim received by CONTRACTOR from Physicians during the 35 18 period between and including July 1, 2017 2025 through June 30, 2018 2026 for Emergency Services and/or Care 36 19 provided within one year of the Claim being submitted ; and 37 //and 1 20 c. Period Three - $2.50 3.55 per Claim received by CONTRACTOR from Physicians during 2 21 the period between and including July 1, 2018 2026 through June 30, 2019 2027 for Emergency Services and/or 3 22 Care provided within one year of the Claim being submitted. 4 23 d. CONTRACTOR and ADMINISTRATOR agree to a discounted group rate of $2.00 rates in the amounts listed 24 above pr claim, per 5 claim period, if a group, consisting of four programs exists: 1) Medical Safety Net 26 Correctional Health Program, 2) Emergency 6 Medical Services Fund Program, 3) Public Health Services Program, and 4) Correctional Health. 8 27 e. The parties agree that Claims for Emergency Medical Services and/or Care for each 9 28 Period may be received by CONTRACTOR up to three (3) months following the end of each Period and 10 29 that CONTRACTOR shall be reimbursed by COUNTY for said claims upon submission of an 11 30 appropriate invoice to ADMINISTRATOR. 12 31 f. For the purposes of reimbursement to CONTRACTOR, a Claim shall be reimbursed 13 regardless of the 32 when adjudication result, including is complete. Allowable adjudication outcomes include but are not limited to Claims 33 that are paid, denied, 14 duplicates, and/or resubmitted. ADMINISTRATOR expects that CONTRACTOR 34 shall provide timely claiming education to various network providers, and resubmitted.CONTRACTOR shall also 35 maintain low duplicate and resubmission rates. 36 // 37 13 of 16 EXHIBIT A ADVAMCED MEDICAL MANAGEMENT, INC. MA 042-24010971 15 1 2. Upon approval of ADMINISTRATOR, CONTRACTOR may use a portion of any interest 16 2 earned by the Funds or Recovery Funds to offset actual cost of postage associated with any mailings, 17 3 except check and Explanation of Benefit (EOB) mailings, required in accordance with the AgreementContract. 18 Contractor 4 CONTRACTOR shall report to County ADMINISTRATOR the amount of interest charged against postage. 5 CONTRACTOR shall 19 use any remaining interest to reimburse claims in accordance with the AgreementContract.

Contractor Payments. Administration 26 33 1. For fiscal intermediary services provided by CONTRACTOR in accordance with the 27 34 Agreement, COUNTY shall, upon receipt of an appropriate invoice, pay CONTRACTOR monthly, in 28 35 arrears, as follows; provided however the total for each Period shall not exceed COUNTY’s Maximum 29 36 Obligation to INTEMEDIARY for each Period as specified in the Referenced Contract Provisions of the 30 37 Agreement: 31 1 a. Period One – $2.50 3.00 per Claim received by CONTRACTOR from Physicians during the 32 2 period between and including July 1, 2016 2019 through June 30, 2017 2020 for Emergency Services and/or Care 33 3 provided within one year of the Claim being submitted; 34 4 b. Period Two - $2.50 3.00 per Claim received by CONTRACTOR from Physicians during the 35 5 period between and including July 1, 2017 2020 through June 30, 2018 2021 for Emergency Services and/or Care 36 6 provided within one year of the Claim being submitted ; and 37 //and 1 7 c. Period Three - $2.50 3.00 per Claim received by CONTRACTOR from Physicians during 2 8 the period between and including July 1, 2018 2021 through June 30, 2019 2022 for Emergency Services and/or 3 9 Care provided within one year of the Claim being submitted. 4 10 d. Period Four - $3.00 per Claim received by CONTRACTOR from Physicians during the 11 period between and including July 1, 2022 through June 30, 2023 for Emergency Services and/or Care 12 provided within one year of the Claim being submitted. 13 e. Period Five - $3.00 per Claim received by CONTRACTOR from Physicians during the 14 period between and including July 1, 2023 through June 30, 2024 for Emergency Services and/or Care 15 provided within one year of the Claim being submitted. 16 f. CONTRACTOR and ADMINISTRATOR agree to a discounted group rate of $2.00 3.00 per 5 claim if a 17 group, consisting of four programs exists: 1) Medical Safety Net Program, 2) Emergency 6 Medical 18 Services Fund Program, 3) Public Health Services Program, and 4) Correctional HealthHealth Program. 8 e. 19 g. The parties agree that Claims for Emergency Medical Services and/or Care for each 9 20 Period may be received by CONTRACTOR up to three (3) months following the end of each Period and 10 21 that CONTRACTOR shall be reimbursed by COUNTY for said claims upon submission of an 11 22 appropriate invoice to ADMINISTRATOR. 12 f. 23 h. For the purposes of reimbursement to CONTRACTOR, a Claim shall be reimbursed 13 regardless of the 24 when adjudication result, including is complete. Allowable adjudication outcomes include but are not limited to Claims 25 that are paid, denied, 14 duplicates, and/or resubmitted. ADMINISTRATOR expects that CONTRACTOR 26 shall provide timely claiming education to various network providers, and resubmittedCONTRACTOR shall also 27 maintain low duplicate and resubmission rates. 15 28 2. Upon approval of ADMINISTRATOR, CONTRACTOR may use a portion of any interest 16 29 earned by the Funds or Recovery Funds to offset actual cost of postage associated with any mailings, 17 30 except check and Explanation of Benefit (EOB) mailings, required in accordance with the Agreement. 18 Contractor 31 CONTRACTOR shall report to County ADMINISTRATOR the amount of interest charged against postage. 32 CONTRACTOR shall 19 use any remaining interest to reimburse claims in accordance with the 33 Agreement.