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Filename,Attribute,Query,Answer,Provider Type,Place of Service/Service Type,Specialty/Type,Fee Schedule,Methodology,Lesser Of (Y/N),Lesser Of (Notes),Rate Percent,DRG_Code,DRG_Description,CPT_Code,CPT_Description,Revenue_Code,Revenue_Description,Notes,Provider_Type,Reimbursement_Rate,Place of Service/ Service Type,Lower_Bound,Upper_Bound,Place_of_Service,Specialty_Type,Fee_Schedule,Lesser_Of,Lesser_Of_Notes,Rate_Percent,Place of Service,Specialty,Lesser Of,Lesser Of Notes,MD/DO providers,non MD/non DO providers,Medicare Fee Schedule,A.1,A.4,Effective Date,Plan,Group Practice,Reimbursement,Rate,Range,Calculation,Effective_Date,Case_Rate,DocuSign_Envelope_ID,Name,Type,Title,Signature_Date,Address,Professional_Services_Reimbursement,Injectable_Medications_Reimbursement,Non_Prevailing_Medicaid_Allowable,Non_Prevailing_Medicare_Allowable
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A.1_OhioHealth Physician Group Inc.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Contract For Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement's purpose and scope is to outline the reimbursement terms for medically necessary covered services rendered to members by the Provider or Group Practice Providers. The Provider or Group Practice Providers are required to accept as payment in full the lesser of their billed charges or CareSource's fee schedule for such services. The fee schedule is currently set at 107% of the prevailing Ohio Medicaid fee schedule for physician services and 100% of the current Ohio Medicaid fee schedule for non-physician Covered Services. The Agreement also specifies reimbursement rates for injectable medications and anesthesia. CareSource is only allowed to amend reimbursement policies in accordance with Section 6.5 of the Agreement.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,8/26/10,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,8/19/10,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,8/26/10,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,,,,Physician,Not Specified,Not Specified,Ohio Medicaid fee schedule,Fee Schedule,Y,107%,107%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,,,,Non-Physician,Not Specified,Not Specified,Ohio Medicaid fee schedule,Fee Schedule,Y,100%,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,,,,Physician,Not Specified,Injectable Medications,Ohio Medicaid fee schedule,Fee Schedule,Y,107%,107%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,,,,Physician,Not Specified,Anesthesia,ODJFS ASA methodology,Fee Schedule,Y,107%,107%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_OhioHealth Physician Group Inc.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to outline the terms and conditions for the provision of medically necessary covered services to CareSource members by the provider. The scope of the Agreement includes various types of services such as suture removal, hospice care, skilled nursing facility services, durable medical equipment, and urgent care center services. The provider agrees to accept payment in accordance with CareSource's fee schedule and to follow certain guidelines and requirements, including notifying the member's primary care physician and providing copies of visit results.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2-22-08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 2008-02-22.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Hospital,Inpatient Services,General,Ohio Medicaid DRG,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Hospital,Outpatient Services,General,Ohio Medicaid fee schedule,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Ancillary Provider,Home Health And Home Infusion,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,FDB minus 35% with appropriate NDC if not priced by Ohio Medicaid,100%,,,,,,,All services require prior authorization by CareSource,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Skilled Nursing Facility,Skilled Nursing Services,General,Medicare RUG,Billed Charges,N,,85%,,,,,,,85% of the prevailing Medicare RUG based on MDS assessment and CBSA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Provider,Hospice,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,Provider's billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Provider,Durable Medical Equipment,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,Provider's billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Urgent Care Center,Urgent Care Services,General,Global Fee,Billed Charges,N,,,,,,,,,Global fee of $70.00 per visit inclusive of all charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,Provider,Imaging And MRI,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,Provider's billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_Southwest_General_Health_Center_20080222.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Reimbursement and Compensation Covered Families and Children (CFC) Aged Blind and Disabled (ABD),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the reimbursement and compensation terms for medically necessary covered services rendered to members by the Hospital. It specifies the payment rates for inpatient and outpatient services, as well as the methodology for claims processing and payment. The Agreement also includes provisions for outliers, transfers, and annual rate adjustments.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,02-01-2008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,,,,Hospital,Inpatient,CFC,Ohio Medicaid inpatient payment rates,Billed Charges,N,103% of the Ohio Medicaid inpatient payment rates,103%,,,,,,,"Includes DRG base rate, medical and capital add-ons, and outliers",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,,,,Hospital,Inpatient,ABD,Ohio Medicaid inpatient payment rates,Billed Charges,N,105% of the Ohio Medicaid inpatient payment rates,105%,,,,,,,"Includes DRG base rate, medical and capital add-ons, and outliers",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,,,,Hospital,Outpatient,CFC,Ohio Medicaid fee schedule,Billed Charges,N,102% of the Ohio Medicaid fee schedule,102%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,,,,Hospital,Outpatient,ABD,Ohio Medicaid fee schedule,Billed Charges,N,102.5% of the Ohio Medicaid fee schedule,102.50%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Health_System_eff_2_1_08 (1).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Physician/Provider/Group Reimbursement Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose and scope is to outline the reimbursement terms for University Hospitals Medical Group providers when rendering medically necessary covered services to members. The providers will accept payment in full based on the prevailing Ohio Medicaid fee schedule, with certain exceptions and bonuses for pediatricians. The Agreement also includes provisions for following Medicaid guidelines, potential bonus programs, and discussions for a pilot program on reimbursing primary care physicians for Telephone Care.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2008,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 10/07/2005.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,Physician/Provider/Group,Office,Pediatrician,Ohio Medicaid fee schedule,Fee Schedule,Y,"105% for codes 99381-99397 and 99201-99215, 100% for other pediatric services",105%,,,,,,,Quarterly bonus for specific codes and age groups,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,Physician/Provider/Group,Office,MDs and DOs other than Pediatricians,Ohio Medicaid fee schedule,Fee Schedule,Y,105% for services,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,Physician/Provider/Group,Hospital,Neonatology,Ohio Medicaid fee schedule,Fee Schedule,Y,125% for neonate codes 99291-99300,125%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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A.1_UH_Medical_Group 2008.txt,,,,Non-physician,Office,Non-physician,Ohio Medicaid fee schedule,Fee Schedule,Y,100% for covered services,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,Physician/Provider/Group,Office,Anesthesiology,Ohio Medicaid fee schedule,Fee Schedule,Y,100% per ODJFS ASA methodology,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,,,,,,,,,N/A,N/A,99381-99397,Preventive medicine services,N/A,N/A,,Pediatricians,105% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,,,,,,,,,,,,,,,,All other MDs and DOs,105% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,,,,,,,,,N/A,N/A,99201-99215,Office or other outpatient visit,N/A,N/A,,Pediatricians,105% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.1_UH_Medical_Group 2008.txt,,,,,,,,,,,,,,,,,,,All other MDs and DOs,105% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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A.1_UH_Medical_Group 2008.txt,,,,,,,,,,,,N/A,N/A,99291-99300,Critical care services for neonates,N/A,N/A,,N/A,125% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the reimbursement terms between University Hospitals Health Systems, Inc. and the Payor for medically necessary Covered Services rendered to Members. It specifies the payment rates for inpatient and outpatient services based on the prevailing Ohio Medicaid DRG and Fee Schedule. The Agreement also emphasizes the parties' commitment to following Ohio Medicaid guidelines for claims processing and payment. Additionally, it mentions the need for a rate increase discussion and the potential termination of the Agreement if an agreement cannot be reached.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"August 31, 2006",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"August 31, 2006",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"August 31, 2006",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",,,,Hospital,Inpatient,N/A,Ohio Medicaid DRG,Fee Schedule,N,,105%,,,,,,,105% of the prevailing Ohio Medicaid DRG rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",,,,Hospital,Outpatient,N/A,Ohio Medicaid Fee Schedule,Fee Schedule,N,,102.50%,,,,,,,102.5% of the prevailing Ohio Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"A.1_University_Hospitals_Health_Systems,_Inc_20060831.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the reimbursement and compensation terms for medically necessary covered services rendered to members by various healthcare providers. It specifies that the providers shall accept payment in full based on the Medicare allowed amount applicable to them. The Agreement covers inpatient and outpatient services, home health and home infusion, hospice, skilled nursing facility, durable medical equipment, urgent care center, and imaging and MRI services. It also includes requirements for providers regarding scheduling, eligibility verification, follow-up care, communication with primary care physicians, and referral to emergency care.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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A.2_Southwest_General_Health_Center.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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A.2_Southwest_General_Health_Center.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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A.2_Southwest_General_Health_Center.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.2_Southwest_General_Health_Center.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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A.2_Southwest_General_Health_Center.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,03/17/08,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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A.2_Southwest_General_Health_Center.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Hospital,,N/A,Medicare allowed amount,Fee Schedule,Y,Payment cannot exceed the Payment listed in this Medicare Addendum,100%,,,,,,,100% of the Medicare allowed amount,,,Inpatient and Outpatient Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Home Health,,N/A,Medicare allowed amount,Fee Schedule,Y,Payment cannot exceed the Payment listed in this Medicare Addendum,100%,,,,,,,100% of the Medicare allowed amount,,,Home Health And Home Infusion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Hospice,,N/A,Medicare allowed amount,Fee Schedule,Y,Payment cannot exceed the Payment listed in this Medicare Addendum,100%,,,,,,,100% of the Medicare allowed amount,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Skilled Nursing Facility,,N/A,Medicare RUG rates,Fee Schedule,Y,Payment cannot exceed the payment listed in this Medicare Addendum,100%,,,,,,,RUG group rates are ALL INCLUSIVE,,,Skilled Nursing Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Durable Medical Equipment,,N/A,Medicare allowed amount,Fee Schedule,Y,Payment cannot exceed the Payment listed in this Medicare Addendum,100%,,,,,,,100% of the Medicare allowed amount,,,Durable Medical Equipment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Urgent Care Center,,N/A,Global fee,Billed Charges,N,,N/A,,,,,,,$70.00 per visit inclusive of all charges,,,Urgent Care Center,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,Imaging and MRI,,N/A,Medicare allowed amount,Fee Schedule,Y,Payment cannot exceed the Payment listed in this Medicare Addendum,100%,,,,,,,100% of the Medicare allowed amount,,,Imaging And MRI,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.2_Southwest_General_Health_Center.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Integrated Care Delivery System REIMBURSEMENT FOR MEDICARE/MEDICAID Addendum to Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement's purpose and scope is to establish the reimbursement terms for medically necessary services rendered to members by providers. Providers are required to accept payment in full based on either their billed charges or the Medicare/Medicaid allowed amount. The Agreement also includes provisions for payment of injectable medications and the right for CareSource to amend reimbursement policies.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,Billed Charges or 100% of the Medicare allowed amount,,,,,,,,For Medically Necessary Services covered by the Medicare benefit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,,,,Provider,N/A,Injectable medications,Medicare fee schedule,Fee Schedule,Y,Medicare fee schedule or specialty pharmacy benefits manager,,,,,,,,Injectable medications will generally be paid according to the Medicare fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,,,,Provider,N/A,Waiver services,Ohio Medicaid fee schedule,Fee Schedule,Y,Billed Charges or 100% of the prevailing Ohio Medicaid fee schedule,,,,,,,,For services covered by the Medicaid benefit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician (1).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
A.3 MD DO Non Physician.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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A.3 MD DO Non Physician.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Integrated Care Delivery System REIMBURSEMENT FOR MEDICARE/MEDICAID Addendum to Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement's purpose and scope is to establish the reimbursement terms for medically necessary services provided to members by healthcare providers. The providers are required to accept payment in full based on either their billed charges or the Medicare/Medicaid allowed amount. The Agreement also includes provisions for payment of injectable medications and the right for CareSource to amend reimbursement policies.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,,,,Provider,N/A,N/A,Medicare allowed amount,Fee Schedule,Y,Billed charges or Medicare allowed amount,100%,,,,,,,Payment cannot exceed the Payment listed in this Medicare Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,,,,Provider,N/A,N/A,Ohio Medicaid fee schedule,Fee Schedule,Y,Billed charges or Ohio Medicaid fee schedule,100%,,,,,,,For waiver services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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A.3 MD DO Non Physician.txt,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C11221659AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Accredo_Custom Specialty Pharmacy Network Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers indemnification, limitation of liability, dispute resolution, compliance with regulatory requirements, assignment, non-exclusivity, and notice. The Agreement is binding upon the Parties and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,11-3358535,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"February 7, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170207,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Accredo_Custom Specialty Pharmacy Network Agreement FE_20170207_Dually Executed Contract-all states and LOB's-ID C11221659AA.txt,,,,,,,,Billed Charges,,,,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,Hospital,,,,,Inpatient,Trach,Billed Charges,Y,Allowable,70%,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Adena Health System National Template Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties and establishes the governing law and venue for any arbitration or legal proceedings. It also includes provisions regarding the authority of the Provider and CareSource Network Partners LLC to bind their respective affiliates to the terms of the Agreement. Additionally, the Agreement addresses the potential for changes in law and compliance with regulatory requirements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Adena Health System National Template Agreement C19460229AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-01-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,04-01-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,105%,,,,,,,,,,,,,,,,,,,Inpatient,General,Y,105% of the Ohio Medicaid DRG or 100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Ohio Medicaid fee schedule,Fee Schedule,,,105%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,105% of the Ohio Medicaid fee schedule or 100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,102%,,,,,,,,,,,,,,,,,,,Inpatient,General,Y,102% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,102%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,102% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Reference Laboratory,Y,100% of the Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Home Health,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Other,Y,100% of the prevailing Ohio Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Hospice,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Other,Y,100% of the prevailing Ohio Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena Health System National Template Agreement C19460229AA.txt,,,,Physician,,,Ohio Medicaid fee schedule,Fee Schedule,,,105%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,105% of the prevailing Ohio Medicaid fee schedule for physician services,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,200%,,,,,,,,,,,,,,,,,,,Inpatient,General,Y,200% of the Medicare allowed amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,200%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,200% of the Medicare allowed amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Laboratory,Y,100% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Durable Medical Equipment,Y,100% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Home Health,Y,100% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Hospital,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Outpatient,Hospice,Y,100% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena Health System National Template Agreement C19460229AA.txt,,,,Physician,,,Medicare Allowed Amount,Fee Schedule,,,130%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,130% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish a contractual relationship between CareSource Network Partners LLC and Adena Health System. It includes provisions for reimbursement rates, compensation terms, and the coverage of various products and networks. The Agreement also allows for amendments and includes mechanisms for resolving disputes. Additionally, the Agreement incorporates the Quality Rewards Program and Shared Savings Program.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"July 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,11:59 p.m. December 31st of the Effective Date's initial calendar year,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Facility,Medicare Fee Schedule,Fee Schedule,Y,"190% of MCR for 2022, 185% of MCR for 2023, 180% of MCR for 2024, 175% of MCR for 2025","190%, 185%, 180%, 175%",,,,,,,CareSource Marketplace - Ohio,,,,,,,,,,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Facility,Medicare Fee Schedule,Fee Schedule,Y,"190% of MCR for 2022, 185% of MCR for 2023, 180% of MCR for 2024, 175% of MCR for 2025","190%, 185%, 180%, 175%",,,,,,,CareSource Marketplace - Ohio,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Laboratory,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Durable Medical Equipment,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Home Health,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Hospice,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,Hospital,,Professional and Physician Group Services,Medicare Allowed Amount,Fee Schedule,Y,130% of the Medicare Allowed Amount,130%,,,,,,,,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adena_First_Amendment_and_2022_Quality_Rewards_and_Shared_Savings_Duall Exec.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the compensation schedules for the services provided by the Provider to Georgia Medicaid and PeachCare for Kids members. It specifies the payment rates for inpatient and outpatient services, as well as other services such as home health and hospice care. The Agreement also includes the reimbursement policies for reference laboratory services and physician fees. Additionally, it mentions the Care Management Fee and provides a link to the Georgia Medicaid Fee Schedule for further details.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,75-3106281,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,5/19/17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,5/19/17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Hospital,Inpatient,General,Georgia Medicaid DRG,Billed Charges,Y,105%,105%,,,,,,,Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Hospital,Outpatient,General,Georgia Medicaid Fee Schedule,Billed Charges,Y,105%,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Laboratory,Reference Laboratory,Pathology,Georgia Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,Hospital based reference laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Home Health,Home Health,General,Georgia Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Hospice,Hospice,General,Georgia Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Physician,Physician Services,General,CareSource's fee schedule,Fee Schedule,N,,105%,,,,,,,Equivalent of 105% of GA Medicaid for physician services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,Non-Physician,Non-Physician Services,General,Georgia Medicaid fee schedule,Fee Schedule,N,,90%,,,,,,,90% of current Georgia Medicaid,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Adventist Health Care System_20170701_LOA Comp Schedule_MCD.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It outlines the obligations and responsibilities of both parties and covers areas such as covered services, termination of coverage, indemnification, limitation of liability, dispute resolution, and governing law. The Agreement applies to the provision of healthcare services and is intended to benefit covered persons.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,36-4513042,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 20161010.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,,,,Physician/Provider/Group,,Not Specified,105% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,Y,Provider's billed charges,105%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,,,,Non-Physician,,Not Specified,100% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,Y,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AGC Pediatrics LLC_20161213_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CARESOURCE HOSPITAL AGREEMENT,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Hospital Agreement between CareSource and Akron General Health System. The Agreement outlines the reimbursement and compensation rates for Covered Services provided by the Hospital to Covered Persons. It also establishes the Hospital's participation in the Plan MarketPlace product and sets forth the terms and conditions for Covered Services provided to MyCare Ohio Covered Persons and MarketPlace Covered Persons. The Agreement remains in full force and effect, except for the amendments made in this Eleventh Amendment.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Eleventh,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Akron General Health System_Eleventh Amendment_20171001.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"October 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Akron General Health System_Eleventh Amendment_20171001.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Akron General Health System_Eleventh Amendment_20171001.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Akron General Health System_Eleventh Amendment_20171001.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is October 1, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Inpatient,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,N,,107%,,,,,,,107% of the ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Outpatient,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,N,,100%,,,,,,,100% of the ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Professional Services,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,N,,105%,,,,,,,105% of the ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Inpatient and Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,151% of the Medicare Allowed Amount,151%,,,,,,,For MarketPlace Covered Persons,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Professional Services,General,Medicare Allowed Amount,Fee Schedule,Y,130% of the Medicare Allowed Amount,130%,,,,,,,For MarketPlace Covered Persons,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Anesthesia Services,General,ASA unit,Per Diem,N,,,,,,,,,$26.00 per ASA unit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Unpriced/Unlisted Codes,General,Billed Charges,Billed Charges,Y,"60% of billed charges for inpatient, 50% for outpatient, 45% for professional services","60%, 50%, 45%",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,GROUP AGREEMENT,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between Plan and Group Practice for the provision of contracted services to covered persons. It establishes the relationship as independent entities and includes provisions for the transfer of medical records, summary suspension of providers, insolvency or discontinuance of operations, notification of license or privilege restrictions, responsibility for acts or omissions, limitation of liability, inspections, use of names, governing law, amendment procedures, entire agreement, dispute resolution, release of information, notice requirements, and conflict resolution.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,,,,Group Practice,,Not specified,105% of the prevailing Ohio Medicaid fee schedule for physician services,Fee Schedule,,Group Practice's billed charges or CareSource's fee schedule,105%,,,,,,,For Medically Necessary Covered Services rendered to Members,,,,,,,,,,,,Not specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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Alliance Physicians Inc.txt,,,,Group Practice,,Non-physician Covered Services,100% of the current Ohio Medicaid fee schedule,Fee Schedule,,Group Practice's billed charges or CareSource's fee schedule,100%,,,,,,,For Medically Necessary Covered Services rendered to Members,,,,,,,,,,,,Not specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law between CareSource and Provider. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if disputes are not resolved. The Agreement also includes provisions for indemnification and limitation of liability.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,02/13/2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,70%,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,,,,Home Health and Home Infusion,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Home,Various,Y,Provider's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,,,,Home Infusion Therapy Drugs,,,Medicare Average Sale Price + 6%,Fee Schedule,,,,,,,,,,"For unlisted codes, reimbursement is based on Medicare Average Sale Price + 6% when a valid NDC code is billed.",,,,,,,,,,,,Home,Various,Y,Provider's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Ambient Healthcare of Georgia Inc dually executed contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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American Health Network of IN_20140916_Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The name of the Agreement is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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American Health Network of IN_20140916_Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between the Plan and the Group Practice. It covers various aspects such as indemnification, limitation of liability, dispute resolution, compliance with regulatory requirements, assignment, non-exclusivity, and notice. The purpose of the Agreement is to establish a binding agreement between the Parties and govern their relationship. The scope of the Agreement includes the rights and obligations of both Parties, as well as the procedures for resolving disputes and complying with regulatory requirements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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American Health Network of IN_20140916_Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-2108729,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 2014-09-16.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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American Health Network of IN_20140916_Contract.txt,,,,Provider,,Not Specified,100% of the Medicare allowed amount,Fee Schedule,Y,Billed Charges or Allowable,Not Specified,,,,,,,"Injectable medications will generally be paid according to the Medicare fee schedule, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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American Health Network of IN_20140916_Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between the Provider and CareSource for the provision of Covered Services. The scope of the Agreement includes payment rates, claim denial appeals, actions against members, governing law and venue, amendment procedures, and termination provisions.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,82-4681345,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"American Oncology Partners, P.A._20230308_ Eighth Amendment Updated MP Rates.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between Provider and CareSource Network Partners LLC. It covers the binding authority of Provider and CareSource, changes in law, compliance with regulatory requirements, assignment of the Agreement, non-exclusivity, entire agreement, enforceability and waiver, regulatory approval, notice requirements, utilization review, termination of Covered Services, indemnification, limitation of liability, period of limitations, dispute resolution, and governing law.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,32-0073934,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,,,,Professional Services,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,Not Specified,Yes,100%,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,,,,Professional Services,,,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,Not Specified,Not Specified,Yes,100%,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template (1).txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law between the Parties. It establishes the obligation to work together in good faith to resolve any disputes and provides a two-level dispute resolution mechanism. If a dispute is not resolved within a certain timeframe, it can be referred to binding arbitration. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to provide a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,32-0073934,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Anderson Family Medicine PC_20170131_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""SECOND AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND APPALACHIAN REGIONAL HEALTHECARE, INC.""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource Network Partners LLC and Appalachian Regional Healthcare, Inc. The scope of the Agreement includes adding a Plan Compensation Schedule, adding hospitals to the Agreement, and maintaining all other terms and conditions of the original Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,45-2696517,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,6/21/2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,6/21/2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,Inpatient Facility Services,N/A,Medicare Allowed Amount,Billed Charges,Y,168% of the Medicare Allowed Amount,168%,,,,,,,"Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,Outpatient Facility Services,N/A,Total Eligible Billed Charges,Billed Charges,Y,65% or 60% of total eligible billed charges depending on the hospital,65% or 60%,,,,,,,"Barbourville ARH, Mary Breckinridge ARH, McDowell ARH, Morgan County ARH - 65%; Middlesboro ARH, Tug Valley ARH Regional Medical Center, Whitesburg ARH, Harlan ARH, Hazard ARH Regional Medical Center - 60%",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,Professional Services,N/A,Medicare Allowed Amount,Billed Charges,Y,165% of the Medicare Allowed Amount,165%,,,,,,,Professional Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,"Home Health, Hospice, SNF, and Dialysis",N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Home Health, Hospice, SNF, and Dialysis Reimbursement Rate",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,Reference Lab and DME,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Reference Lab and DME Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Appalachian Regional Healthcare Inc_20170312_Dually Exe-KY MP-C13439125AA.txt,,,,Hospital,Injectable Medications,N/A,Medicare Fee Schedule,Billed Charges,Y,According to the 100% of the Medicare Fee Schedule,100%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,H2bnySCk57XNnqTbmL-j2g,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish a framework for resolving disputes between the Parties in a timely manner. It outlines the process for dispute resolution, including first-level and second-level discussions, and the option for binding arbitration if necessary. The Agreement also specifies the governing law and venue for any disputes. Additionally, it includes provisions for indemnification and limitation of liability.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,82-0709593,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,82-0709593,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Atlanta Plus Urgent Care_20190805_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to outline the terms and conditions between CareSource and the Provider. It covers various aspects such as the termination of covered services, indemnification, limitation of liability, dispute resolution, and governing law. The scope of the Agreement includes the obligations and responsibilities of both parties, as well as the procedures for resolving disputes and the applicable laws and venues.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-0705892,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,58-0705892,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,20170410,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170410,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,,,,Physician/Provider/Group,,Not Specified,100% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,,,,Physician/Provider/Group,,Non-physician Covered Services,90% of the current Georgia Medicaid fee schedule,Fee Schedule,,Provider's billed charges,90%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20170410_ National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FOURTH AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND AU MEDICAL ASSOCIATES, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and AU Medical Associates, Inc. The scope of the Agreement includes adding Surgery Center of Columbia County to the Affiliations Attachment and incorporating the Affiliation Attachment into the Agreement. It also includes adding Exhibit C - Plan Compensation Schedule CareSource Georgia Medicaid Ambulatory Surgery Center to the Compensation Schedule. The Agreement states that all defined terms in the original Agreement remain the same, and except for the amendments, the terms of the original Agreement remain in full force and effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,74-3171980,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1598775231,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"July 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is April 10, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,GA Medicaid Fee Schedule,Fee Schedule,Y,100% of the Prevailing GA Medicaid Fee Schedule,,,,,,,,Provider must comply with CareSource's Medical Management guidelines and contact the CareSource Member Check Line or internet site for eligibility. Credentialing of all physicians consistent with CareSource standards is required. Provider must refer CareSource members back to their primary care physician for follow-up unless follow-up is inclusive with the initial service rendered.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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AU Medical Associates_20220222_Fourth Amendment_Adding GA MCD ASC.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if disputes are not resolved. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170511,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",,,,Hospital,,Trach,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,,Y,Allowable,,,,,,,,,,,,,,,,,,,,,,,,
|
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"AU Medical Center, Inc_20170511_Dually Executed.txt",,,,Hospital,,General,Georgia Medicaid DRG,Fee Schedule,,,100%,,,,,,,Payments to Provider shall be based upon the payment rate in effect on the Member's date of admission for inpatient services.,,,,,,,,,,,,Inpatient,,Y,Allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",,,,Hospital,,General,Georgia Medicaid Fee Schedule,Fee Schedule,,,N/A,,,,,,,Outpatient Hospital Services other than those specifically identified below shall be paid based upon the Provider's Billed Charges multiplied by the Provider's Interim Outpatient Rate (IOR).,,,,,,,,,,,,Outpatient,,Y,Allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",,,,Hospital,,"Laboratory/Pathology, Injectable Drugs, Dialysis and Oral Medications, Orthotics and Prosthetics, Emergency Ambulatory Services, Birthing and Parenting Classes",Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,CareSource shall reimburse Provider the lesser of 100% of the Georgia Medicaid Fee Schedule or 100 % of Provider's allowable billed charges for the following services.,,,,,,,,,,,,Outpatient,,Y,Allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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"AU Medical Center, Inc_20170511_Dually Executed.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law between CareSource and Provider. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if disputes are not resolved. The Agreement also includes indemnification and limitation of liability clauses. The purpose of the Agreement is to establish the terms and conditions for the relationship between CareSource and Provider.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,80-0024651,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",,,,Physician/Provider/Group,,Not Specified,100% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",,,,Physician/Provider/Group,,Non-physician Covered Services,90% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,,Provider's billed charges,90%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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"Augusta Obstetrics and Gynecology Specialists, LLC_20170817_National Agreement Template.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if necessary. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,09-04-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"The Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for indirect medical education (IME), disproportional share (DSH) and outlier payments if applicable.",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Professional Services,,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"If the contract doesn't specify terms for reimbursement, then CareSource pays the provider at 100% of the Medicare set cost/price for the specific procedure or service.",,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Professional Services,,N/A,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid Fee Schedule,100%,,,,,,,CareSource reserves the right to amend reimbursement policies with advanced notice.,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Group/Ancillary,,N/A,Indiana Medicaid Fee Schedule,Fee Schedule,Y,130% of the prevailing Indiana Medicaid Fee Schedule for Professional Services,130%,,,,,,,All Services payable per IHCP guidelines.,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Injectable medications will generally be paid according to the Medicare Fee Schedule except for those drugs that may be available through a specialty pharmacy benefits manager.,,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,Professional Services,,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,CareSource reserves the right to amend reimbursement policies with advanced notice.,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Avenues Recovery Center of Fort Wayne_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and Provider. It covers various aspects such as indemnification, limitation of liability, dispute resolution, and governing law. The Agreement also outlines the authority of the parties, the requirement to comply with regulatory requirements, and the non-exclusivity of the agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,34-4445373,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-08-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20190101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon Secours Mercy Health_20190101_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon Secours Mercy Health_20190101_Base Contract.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,Billed Charges or Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon_Secours_Mercy_Third_Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon_Secours_Mercy_Third_Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners, LLC and Bon Secours Mercy Health. The Agreement outlines the terms and conditions of the contract between the two parties, including the compensation terms and the products or networks covered. The scope of the Agreement includes the deletion and replacement of Exhibit A and Exhibit C, as well as the continuation of the Agreement's terms, except as expressly amended.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon_Secours_Mercy_Third_Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon_Secours_Mercy_Third_Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Bon_Secours_Mercy_Third_Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,"31-1091597, 31-0537085, 31-0538532, 27-1408630, 31-0830955, 02-0701635, 34-1577110, 34-4431174, 34-4428250, 34-4445373, 31-1556401, 34-1105619, 31-0785684, 34-0714704, 34-0864230, 34-0505560",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"October 1, 2021",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"October 1, 2021.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,103.50%,,,,,,,"For inpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 103.5% of the Ohio Medicaid DRG (based on Hospital's current ODM payment rate).",,,,,,,,,,,,Inpatient,Acute Care,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid Fee Schedule,Fee Schedule,,,103.50%,,,,,,,"For outpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 103.5% of the prevailing Ohio Medicaid Fee schedule.",,,,,,,,,,,,Outpatient,Ambulatory/Outpatient Surgery,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,103.50%,,,,,,,"For inpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital the lesser of 103.5% of the Ohio Medicaid DRG (based on Hospital's current ODM payment rate) or 100% of Hospital's allowable billed charges.",,,,,,,,,,,,Inpatient,Acute Care,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid Fee Schedule,Fee Schedule,,,105.00%,,,,,,,"For outpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 105.0% of the prevailing Ohio Medicaid Fee schedule.",,,,,,,,,,,,Outpatient,Ambulatory/Outpatient Surgery,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,101%,,,,,,,"For inpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital the lesser of 101% of the Ohio Medicaid DRG (based on Hospital's current ODM payment rate) or 100% of Hospital's allowable billed charges.",,,,,,,,,,,,Inpatient,Acute Care,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid Fee Schedule,Fee Schedule,,,101.00%,,,,,,,"For outpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 101.0% of the prevailing Ohio Medicaid Fee schedule.",,,,,,,,,,,,Outpatient,Ambulatory/Outpatient Surgery,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,101.00%,,,,,,,"For inpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 101.0% of the Ohio Medicaid DRG (based on Hospital's current ODM payment rate).",,,,,,,,,,,,Inpatient,Acute Care,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,"For outpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital the lesser of 100% of the prevailing Ohio Medicaid Fee schedule or 100% of Hospital's allowable billed charges.",,,,,,,,,,,,Outpatient,Ambulatory/Outpatient Surgery,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid DRG,Fee Schedule,,,105.00%,,,,,,,"For inpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital 105.0% of the Ohio Medicaid DRG (based on Hospital's current ODM payment rate).",,,,,,,,,,,,Inpatient,Acute Care,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Bon_Secours_Mercy_Third_Amendment.txt,,,,Hospital,,,Ohio Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,"For outpatient services rendered at Hospital facilities as set forth below, Plan shall reimburse Hospital the lesser of 100% of the prevailing Ohio Medicaid Fee schedule or 100% of Hospital's allowable billed charges.",,,,,,,,,,,,Outpatient,Ambulatory/Outpatient Surgery,Y,100% of Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Bon_Secours_Mercy_Third_Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,10F2204E-DE32-471C-A407-E9DA119E1ED1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Sixth Amendment between CareSource and Brightview LLC. It aims to amend the existing CareSource Provider Agreement and includes provisions related to reimbursement for Medicaid services, the addition of an Integrated Delivery System, negotiation of alternate payment models, monitoring of drug testing utilization, compliance with CareSource policies, and the definition of terms.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,12-03-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is June 1, 2021.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicaid,Mental Health,Ohio Medicaid fee schedule,Fee Schedule,Y,Group Practice's billed charges or CareSource's fee schedule,100%,,,,,,,Urinary Drug Testing to be reimbursed as set forth below,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicaid,Mental Health,Ohio Medicaid fee schedule,Fee Schedule,Y,"Definitive Urinary Drug Testing: G0480, G0481, G0482, G0483",93.80%,,,,,,,Definitive Urinary Drug Testing reimbursement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicaid,Mental Health,Ohio Medicaid fee schedule,Fee Schedule,Y,"Presumptive Urinary Drug Testing: 80305, 80306, 80307",93.80%,,,,,,,Presumptive Urinary Drug Testing reimbursement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicare/Medicaid (MyCare),Mental Health,Medicare Allowed Amount,Fee Schedule,Y,Provider's billed charges or Medicare Allowed Amount,100%,,,,,,,For Medicare portion of MyCare Member's benefit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicare/Medicaid (MyCare),Mental Health,Medicare Allowed Amount,Fee Schedule,Y,"Definitive Urinary Drug Testing: G0480, G0481, G0482, G0483",75.04%,,,,,,,Definitive Urinary Drug Testing reimbursement for Medicare portion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicare/Medicaid (MyCare),Mental Health,Ohio Medicaid Fee Schedule,Fee Schedule,Y,Medicaid portion of MyCare Member's benefit,100%,,,,,,,For Medicaid portion of MyCare Member's benefit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicare/Medicaid (MyCare),Mental Health,Ohio Medicaid Fee Schedule,Fee Schedule,Y,"Definitive Urinary Drug Testing: G0480, G0481, G0482, G0483",93.80%,,,,,,,Definitive Urinary Drug Testing reimbursement for Medicaid portion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview LLC_20210601_Sixth Amendment_Adj UDT rates for MCD OH MyCare (1).txt,,,,Community Mental Health Center,Medicare/Medicaid (MyCare),Mental Health,Ohio Medicaid Fee Schedule,Fee Schedule,Y,"Presumptive Urinary Drug Testing: 80305, 80306, 80307",93.80%,,,,,,,Presumptive Urinary Drug Testing reimbursement for Medicaid portion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource and Brightview LLC. The scope of the Agreement includes adding D-SNP reimbursement to the agreement, while all other terms and provisions of the agreement remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,47-2519577,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"6th day of October, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is the 8th day of March, 2016.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,,,,Group Practice,Professional Services,Not specified,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Injectable medications paid according to 100% of the Medicare Fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment One.txt,,,,Group Practice,Not specified,Not specified,Ohio Medicaid Fee Schedule,Billed Charges,Y,Medicare Covered Person Cost Share or Medicaid allowable amount,Not specified,,,,,,,D-SNP Covered Persons have no cost share obligations,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a contractual relationship between CareSource, an Ohio not-for-profit corporation, and Brightview LLC. The Agreement outlines the terms and conditions for the provision of services by Brightview LLC to CareSource. The scope of the Agreement includes the amendment of the original CareSource Provider Agreement to add the Ohio Community Transition Program Plan Compensation, effective from October 26, 2018. All other terms and provisions of the Agreement remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,47-2519577,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"October 26, 2018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is October 26, 2018.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,,,,Not Specified,Not Specified,Not Specified,Ohio Medicaid,Fee Schedule,Y,100% of the prevailing Ohio Medicaid fee schedule,Not Specified,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider in accordance with the terms of this Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,,,,Not Specified,Not Specified,Not Specified,CareSource's proprietary fee schedule,Fee Schedule,Y,CareSource's proprietary fee schedule when applicable,Not Specified,,,,,,,CareSource reserves the right to amend reimbursement policies with advanced notice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Amendment Two.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Brightview_Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between the Group Practice and the Plan Provider. It covers various aspects such as release of information, notice requirements, conflict resolution, compensation provisions, and miscellaneous provisions. The Agreement is governed by applicable federal and state laws and includes specific provisions for the state of Ohio.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Brightview_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,Dec-09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,Dec-09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,,,,Physician,,,Ohio Medicaid fee schedule,Fee Schedule,,,105%,,,,,,,,,,,,,,,,,,,Not Specified,MD/DO providers,Y,105%,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,,,,Non-Physician,,,Ohio Medicaid fee schedule,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Not Specified,non MD/non DO providers,Y,100%,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Brightview_Base Contract.txt,,,,Physician,,,Medicare allowed amount,Fee Schedule,,,100%,,,,,,,"When combined with all other sources of payment, CareSource's Payment cannot exceed the Payment listed in existing Medicare Addendum.",,,,,,,,,,,,Not Specified,Not Specified,Y,100% of the Medicare allowed amount,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Base Contract.txt,,,,Non-Physician,,,Medicare allowed amount,Fee Schedule,,,100%,,,,,,,"When combined with all other sources of payment, CareSource's Payment cannot exceed the Payment listed in existing Medicare Addendum.",,,,,,,,,,,,Not Specified,Not Specified,Y,100% of the Medicare allowed amount,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a fourth amendment to the CareSource Provider Agreement between CareSource and Brightview LLC. It aims to amend the original Agreement by adding a CareSource Community Mental Health Center Plan Compensation Schedule, terminating a Physician/Provider/Group Reimbursement for Medicaid Addenda to Contract, and clarifying the definitions of terms used in the Agreement. The Agreement's purpose is to establish the terms and conditions for the provision of medically necessary covered services to members by Brightview LLC, including reimbursement rates and prior authorization requirements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,47-2519577,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"April 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,,,,Community Mental Health Center,Outpatient,Mental Health,Ohio Medicaid,Fee Schedule,Y,Provider's billed charges,100%,,,,,,,For Medically Necessary Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,,,,Community Mental Health Center,Outpatient,Mental Health,Ohio Medicaid,Fee Schedule,Y,Provider's billed charges,100%,,,,,,,Presumptive Urinary Drug Testing (UDT),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,,,,Community Mental Health Center,Outpatient,Mental Health,Ohio Medicaid,Fee Schedule,Y,Provider's billed charges,75%,,,,,,,Definitive Urinary Drug Testing (UDT),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,,,,,,,,,,,,N/A,N/A,80307,Presumptive UDTs,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Brightview_Fourth Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,Definitive UDTs,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the rights and obligations of the Hospital and the Plan. It outlines the termination process, the provision of services, and the responsibilities of each party. The scope of the Agreement includes the provision of medically necessary services to covered persons, adherence to Plan requirements, and compliance with applicable laws and regulations.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,4-20-07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_OH.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 4-20-07.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_OH.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Cabell Huntington Hospital_Base Contract_WV,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between the Plan and the Hospital. It covers various aspects such as termination, suspension, indemnification, limitation of liability, dispute resolution, compliance with regulatory requirements, assignment, non-exclusivity, and notice. The purpose of the Agreement is to establish a binding relationship between the Parties and govern their interactions.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,WV,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington Hospital_Base Contract_WV.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,4/22/15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,7/18/2013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington Hospital_Base Contract_WV.txt,,,,Hospital,,General,Billed Charges,Billed Charges,Y,95% of billed charges,95%,,,,,,,All Hospital services reimbursement rate,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,,,,Hospital,,General,Medicare Allowed Amount,Fee Schedule,Y,95% of billed charges,95%,,,,,,,All Hospital services reimbursement rate,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington Hospital_Base Contract_WV.txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Addendum.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington_OH MCD Addendum.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Addendum.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions for the provider to serve members of the MCP's Medicaid program. It includes provisions related to financial liability, licensing requirements, medical record transfer, quality assessment, termination procedures, and member rights. The Agreement also specifies the minimum number of Medicaid members that primary care physicians must serve and the services that hospitals must provide.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington_OH MCD Addendum.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Addendum.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Addendum.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cabell Huntington_OH MCD Addendum.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,12-12-2006,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 11/28/05.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Addendum.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the reimbursement terms for medically necessary covered services rendered by the Hospital and Provider/Group Practice Providers to Members. It specifies the payment rates based on the prevailing Ohio Medicaid fee schedule or the Hospital's allowable billed charges. The Agreement also includes provisions for outliers, transfers, and reimbursement for other services such as home health and hospice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cabell Huntington_OH MCD Compensation.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,4-30-07,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Cabell Huntington_OH MCD Compensation.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,12-12-2006,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,Hospital,Inpatient,General,Ohio Medicaid DRG,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,Hospital,Inpatient,Neonatal Intensive Care,Ohio Medicaid DRG,Billed Charges,Y,100% of Hospital's allowable billed charges,110%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,Hospital,Outpatient,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,Provider,Physician Services,General,Ohio Medicaid fee schedule for physician services,Billed Charges,Y,105% of the prevailing Ohio Medicaid fee schedule,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,Provider,Non-Physician Covered Services,General,Ohio Medicaid fee schedule,Billed Charges,Y,100% of the current Ohio Medicaid fee schedule,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cabell Huntington_OH MCD Compensation.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Health Care Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a seventh amendment to the Health Care Services Agreement between CareSource and Cincinnati Children's Hospital Medical Center. It updates the reimbursement schedules for the Ohio and Kentucky Marketplace plans and rescinds a termination notice previously sent by CareSource to the Hospital. The Agreement remains in full force and effect, with the terms of the Seventh Amendment controlling in the event of a conflict. The purpose of the Agreement is to establish the reimbursement rates for Covered Services rendered by the Hospital to members, based on a percentage of the Hospital's billed charges or the Medicare Allowed Amount. The Agreement also includes provisions for the conversion to a percent of Medicare within 90 days, the use of specific Tax Identification Numbers for billing, and the conversion of the contract and arrangement to HealthVine, LLC. Additionally, the Parties agree to work towards an upside only value-based reimbursement structure by January 1, 2024, and the Hospital is required to provide advance written notice of any increase to its Chargemaster.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Seventh,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio and Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,310833936 & 311459815,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"August 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"August 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,50% of the Hospital's billed charges,50%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF, and DME",N/A,Billed Charges,Billed Charges,Y,50% of the Hospital's billed charges,50%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,All Other Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,200% of Medicare Allowed Amount,200%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,Services without Medicare Allowed Amount,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CareSource and CCHMC Marketplace 8-1-2022 Amendment Final.txt,,,,Hospital,Injectable Medications,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Caresource Exchange Hosp 110121 Partial_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,FOURTH AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement is a Fourth Amendment to an existing agreement between CareSource Network Partners LLC and The Health and Hospital Corporation of Marion County. The purpose of the Amendment is to amend the existing Agreement and replace certain exhibits related to compensation schedules for covered services rendered by the Hospital. The scope of the Agreement is limited to the specific amendments and replacements outlined in the Fourth Amendment.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Caresource Exchange Hosp 110121 Partial_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-6005697,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,11-05-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,Inpatient and Outpatient Facility,N/A,Medicare Allowed Amount,Fee Schedule,Y,160% of the Medicare Allowed Amount,160%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,"Home Health, Hospice and Dialysis",N/A,Medicare Allowed Amount,Fee Schedule,Y,125% of the Medicare Allowed Amount,125%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,125% of the Medicare Allowed Amount,125%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,Ambulance,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,Professional Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,130% of the Medicare Allowed Amount,130%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,DME,N/A,Medicare Fee Schedule,Fee Schedule,Y,100% of the Medicare Fee Schedule or 75% of MSRP,100% or 75% of MSRP,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,Hospital,Outpatient Drug and Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,115% of the Medicare Allowed Amount or AWP minus 15%,115% or AWP minus 15%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,FQHC,N/A,N/A,FQHC Encounter Rate,Fee Schedule,Y,110% of the FQHC Encounter Rate,110%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Caresource Exchange Hosp 110121 Partial_MP.txt,,,,FQHC,Outpatient Drug and Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,115% of the Medicare Allowed Amount or AWP minus 15%,115% or AWP minus 15%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Network Partners LLC Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the obligations and responsibilities of the Parties involved, including the provision of indemnification, limitations of liability, dispute resolution procedures, and the assignment of rights. It also specifies that the Agreement supersedes all other agreements and contains provisions for amendments.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,11-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,11-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,,,,Laboratory,N/A,N/A,75% of the prevailing Georgia (GA) Medicaid fee schedule,Fee Schedule,Y,Provider's billed charges,75%,,,,,,,CareSource reserves the right to amend the reimbursement rate to reflect the national rate when a national contract is executed. CareSource reserves the right to amend reimbursement policies with advanced notice.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLCProvAgree_FullyExe_Effect_11-1-17.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a contract between CareSource Network Partners LLC and Laboratory Corporation of America Holdings. It was entered into on May 25, 2018, and has been amended twice, with the most recent amendment effective as of January 1, 2020. The purpose of the Agreement is to establish the terms and conditions for the provision of healthcare services by Laboratory Corporation of America to CareSource and its affiliates. The Agreement includes provisions related to payment, retroactive denial of claims, termination, and governing law. It also specifies that the Agreement applies to all types of licensed healthcare providers.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,West Virginia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,West Virginia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,13-3757370 & 84-0611484,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,,,,Laboratory,Reference Lab,Laboratory Services,Medicare Fee Schedule,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CaresourceNtwrkPrtnrsLLC_LCAHLCA Second Amendment Add WV Executed 2020.txt,,,,Laboratory,Reference Lab,Laboratory Services,Medicare Fee Schedule,Fee Schedule,Y,105% of the Medicare Allowed Amount,105%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,LCAHLCA-ProvAgree,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement outlines the indemnification and limitation of liability between CareSource and the Provider. It also includes provisions for dispute resolution and governing law. The Agreement may be subject to review and approval by state and federal agencies. It is binding upon the respective legal successors and assignees of the Parties. The Agreement supersedes all other agreements regarding the subject matter.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,5/25/18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,,,,Laboratory,N/A,N/A,75% of 2017 Kentucky Medicare fee schedule,Fee Schedule,Y,Provider's billed charges,75%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,,,,Laboratory,N/A,N/A,75% of 2017 Indiana Medicare fee schedule,Fee Schedule,Y,Provider's billed charges,75%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSourceNtwrkPrtnrsLLC_LCAHLCA-ProvAgree_FullyExe_Effective date.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource_and_OSU_2023_VBR_Program_Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions for the transmission and sharing of data between two parties. The scope of the Agreement includes the testing of software and systems, limitation of access to data, security controls and disaster recovery, and the handling of data sent in error.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the given context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CareSource_and_OSU_2023_VBR_Program_Addendum-Dually Exectued.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C20838433AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Health Care Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a Health Care Services Agreement between CareSource and Cincinnati Children's Hospital Medical Center. The Agreement outlines the terms and conditions for reimbursement of Covered Services provided by the Hospital to members of the Ohio and Kentucky Marketplace plans. The Agreement also includes provisions for the conversion to a percent of Medicare reimbursement and the potential transition to Health Vine, LLC. The scope of the Agreement covers the period from August 1, 2022, to December 31, 2023, with the possibility of future amendments and a transition to an upside-only value-based reimbursement structure by January 1, 2024.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Seventh,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio and Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,310833936 & 311459815,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"August 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is August 1, 2022.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,07/29/2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,50% of the Hospital's billed charges,50%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF, and DME",N/A,Billed Charges,Billed Charges,Y,50% of the Hospital's billed charges,50%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,All Other Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,200% of Medicare Allowed Amount,200%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,Services without Medicare Allowed Amount,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCHMC Cincinnati Childrens Marketplace 8-1-2022 Amendment Final-Base Contract ID C20838433AA.txt,,,,Hospital,Injectable Medications,N/A,Billed Charges,Billed Charges,Y,48% of the Hospital's billed charges,48%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing Provider Agreement between CareSource and DEGC Enterprises (U.S.), Inc. dba CCS Medical. The Agreement outlines the terms and conditions for the provision of healthcare services to covered persons. The scope of the Agreement includes the addition of an attachment titled ""Exhibit C - Indiana Plan Compensation Schedules"" which specifies the reimbursement rates for various medical equipment and supplies.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,59-3271823,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,08-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is August 01, 2020.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,DME,N/A,Insulin Supplies,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges or Medicare Allowed Amount,100%,,,,,,,Specific code shall be paid according to the chart below,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,DME,N/A,Urological and Wound,65% of the prevailing Medicare rate,Billed Charges,Y,Provider's billed charges or 65% of the prevailing Medicare rate,65%,,,,,,,Incontinence supplies will reimburse at 65% of Indiana Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,DME,N/A,Ostomy Supplies,Indiana Medicaid Fee Schedule,Billed Charges,Y,Provider's billed charges or Indiana Medicaid Fee Schedule,100%,,,,,,,Ostomy supplies will reimburse at 100% of the Indiana Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,DME,N/A,Urological and Wound Care,80% of Indiana Medicaid fee schedule,Billed Charges,Y,Provider's billed charges or 80% of Indiana Medicaid fee schedule,80%,,,,,,,Urological and Wound Care supplies will reimburse at 80% of Indiana Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,DME,N/A,Incontinence Supplies,65% of Indiana Medicaid fee schedule,Billed Charges,Y,Provider's billed charges or 65% of Indiana Medicaid fee schedule,65%,,,,,,,Incontinence supplies will reimburse at 65% of Indiana Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical IN HIP Hoosier Healthwise - Second Amendment Revised -DEGC signed.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Ancillary Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions for the provision of ancillary services by the Servicer to the Plan. The Agreement outlines the rights and obligations of both parties, including reimbursement for payments made in error, termination provisions, and the responsibilities of each party upon termination. The Agreement also addresses false claims, compliance with applicable laws and regulations, and the transfer of medical records.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 20150101.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,Ohio Medicaid Fee Schedule,Fee Schedule,N,,,,,,,,,"Insulin Infusion Pump, code E0784 - 100% of the prevailing Ohio Medicaid Fee Schedule.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$42.00 each,Billed Charges,N,,,,,,,,,"Scales, code E1639 - $42.00 each.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$368.74 monthly,Billed Charges,N,,,,,,,,,"The rental of an insulin pump, maximum 13 months: Insulin Infusion Pump, code E0784 - $368.74 monthly.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$13.00 per day,Billed Charges,N,,,,,,,,,"Continuous glucose monitoring: Sensor, code A9276 - $13.00 per day.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$685.00 each,Billed Charges,N,,,,,,,,,"Continuous glucose monitoring: Transmitter, code A9277 - $685.00 each.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$585.00 each,Billed Charges,N,,,,,,,,,"Continuous glucose monitoring: Receiver, code A9278 - $585.00 each.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$695.00 each,Billed Charges,N,,,,,,,,,"Omnipod: Personal Device Manager (replacement every 4 years), code E1399 - $695.00 each.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,Durable Medical Equipment,,Not Specified,$34.00 each,Billed Charges,N,,,,,,,,,"Omnipod: Pods, code A9274 - $34.00 each.",,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CCS Medical_DEGC Enterprises US Inc_Ancillary Services Agreement_20150101.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed GA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers various aspects such as summary suspension, indemnification, limitation of liability, dispute resolution, and governing law. The Agreement aims to ensure the fair treatment of Covered Persons and outlines the responsibilities and obligations of both parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"July, 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is August 1, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
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Chattanooga-Hamilton County Hospital Authority_20170801_Dually Executed GA_ MCD.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the rights and obligations between CARESOURCE and CHILDREN'S HOSPITAL AND PHYSICIANS' HEALTHCARE NETWORK, INC. D.B.A. PARTNERS FOR KIDS (PFK). It outlines the conditions for the use of PFK's name, the governing laws, the process for amending the Agreement, and the confidentiality requirements. The Agreement also includes provisions for indemnification, termination, and the return or destruction of protected health information (PHI) and electronic protected health information (ePHI).",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,12-01-2006,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,12-01-2006,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Children's Hospital and Physicians' Healthcare Network_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes changes to the compensation schedules for various healthcare services provided by Community Health Network, Inc. under the CareSource Indiana Marketplace Qualified Health Plan. Additionally, the Agreement clarifies that facilities located within Hamilton and Marion County are not considered in-network or participating providers for the CareSource Indiana Marketplace Plan.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Hospital,Inpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,"Inpatient Reimbursement calculated as sum of operating base rate and capital base rate multiplied by Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Hospital,Outpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,All Procedure Codes not covered by Medicare or Indiana Medicaid shall be non-covered except for Procedure Codes listed in Table 1.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Ambulatory Surgery Center,ASC,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Home Health/Home Infusion,Home Health,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Hospice,Hospice,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Durable Medical Equipment,DME,General,Medicare Allowed Amount,Fee Schedule,Y,120% or MSRP minus 15%,,,,,,,,Reimbursement is 75% of MSRP for codes manually priced.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,Physician/Provider Group/Ancillary,Physician Services,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN HOS mp_Executed-Community HIX BH Amendment 9th.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing Group Practice Agreement between CareSource and Community Physicians of Indiana, Inc. The Agreement includes provisions for state-specific provisions for Indiana, Medicaid plan addendum, plan compensation schedules, and other terms and conditions related to payment of claims, termination, medical record transfer, compliance with laws and regulations, and reimbursement for covered services. The Agreement applies to the services provided by the Provider to Covered Persons under the CareSource Plan in the State of Indiana.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,09-08-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 9/8/16.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,,,,Physician/Provider Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016 (1).txt,,,,Group/Ancillary,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing Group Practice Agreement between CareSource and Community Physicians of Indiana, Inc. The Agreement includes provisions for payment of claims, timing for payment of claims, termination options for the Primary Medical Provider, transfer of medical records, compliance with laws and regulations, and reimbursement policies. The Agreement applies to Covered Services provided to Covered Persons in the State of Indiana.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,09-08-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,09-08-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,,,,Physician/Provider Group,,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHN Provider Group IN Amendment Dually Executed 9.8.2016.txt,,,,Physician/Provider Group,,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a contract between CareSource Georgia, Co. and Children's Healthcare of Atlanta, Inc. It is an amendment to an existing Provider Agreement and its purpose is to modify and update certain sections of the Agreement. The scope of the Agreement includes the provision of health benefit plans and covered services to eligible individuals, as well as the reimbursement of services provided by Children's.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,01-0723254,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1316456825,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,(404) 785-3229,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"June 30, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,08-06-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Ninth Amendment GA MCD_Extend_07.01.2022 -06.30.23_ MP Revisions Eff.07-01-2022.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,2023 04 01 Children's CareSource Amendment CHOA signed 1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to modify certain provisions related to Medicaid PCS - Provider - Attachment 3, Attachment 4, Attachment 5, Exhibit I, and Exhibit J. The Agreement affirms the existing terms and conditions of the Agreement, except for the modifications specified. It also establishes that this Amendment will control in case of any conflicts with the original Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"Jan 25, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,25-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,,,,Hospital,,,"DCH DRG classification (Tricare Version 35 that was in effect for FFS Medicaid January 1, 2019)",Fee Schedule,Y,100% of the DRG payment amount,100%,,,,,,,CareSource shall pay HSOC 100.00% of the DRG payment amount,,,,,,,,,,,,Inpatient,Trach,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,,,,Hospital,,,Billed Charges,Billed Charges,Y,100% of the DRG payment amount,100%,,,,,,,CareSource shall pay HSOC 100.00% of the DRG payment amount,,,,,,,,,,,,Inpatient,Trach,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,,,,,,,,,,,,140,Simple Pneumonia & Pleurisy Age 0-17,881,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA Tenth Amendment GA MCD 2023 04 01 Children's CareSource Amendment CHOA signed_Rates Inpt_Prof.txt,,,,,,,,,,,,140,Simple Pneumonia & Pleurisy Age 0-17,N/A,N/A,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a provider agreement between CareSource Georgia, Co. and Children's Healthcare of Atlanta, Inc. It is intended to amend the existing Provider Agreement between the two parties. The purpose of the Agreement is to outline the terms and conditions for the provision of healthcare services by Children's Hospitals to CareSource members. The scope of the Agreement includes the reimbursement terms for Children's Hospitals, the applicability of the attachment to Children's Hospitals, and the control of the Amendment over conflicting provisions in the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,67.97% of Allowable Charges,67.97%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,67.97% of Allowable Charges,67.97%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHOA_Eighth Amendment _MCD-Commerical PCS Revised_Eff. 05-01-21.txt,,,,,,,,,,,,140,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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CHOA_Second Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and Children's Healthcare of Atlanta, Inc. It covers various aspects such as confidentiality, coding edits, compliance with policies, tiered network assignment, laboratory services, pharmaceutical purchases, reimbursement for health services, timely filing requirements, and the effective term of the agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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CHOA_Second Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Hospital,Inpatient,General,68% of Allowable Charges,Billed Charges,N,,68%,,,,,,,Allowed Amount for inpatient Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Hospital,Outpatient,General,68% of Allowable Charges,Billed Charges,N,,68%,,,,,,,Allowed Amount for outpatient Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Provider,Professional Services,Surgical and Anesthesia,350% of the 2019 Medicare Fee Schedule,Fee Schedule,Y,Allowable Charges,350%,,,,,,,For services with a Medicare Fee assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Provider,Professional Services,All Other Services,280% of the 2019 Medicare Fee Schedule,Fee Schedule,Y,Allowable Charges,280%,,,,,,,For services with a Medicare Fee assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Provider,Professional Services,Services without a Medicare Fee,80% of Allowable Charges,Billed Charges,N,,80%,,,,,,,For services that do not have a 2019 Medicare Fee Assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Provider,Day Treatment Programs,Feeding Program,"$2,025 Per Diem",Per Diem,N,,,,,,,,,Fixed payment for services rendered on a single date of service,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,Provider,Day Treatment Programs,Severe Behavioral Program,"$2,025 Per Diem",Per Diem,N,,,,,,,,,Fixed payment for services rendered on a single date of service,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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CHOA_Second Amendment_QHP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Cincinnati Children's Hospital Medical Center. The amendment includes the addition of a reimbursement for CareSource Just4Me, a qualified health plan for the Health Insurance Exchange or Marketplace. The scope of the Agreement includes the acceptance of payment in full by the Hospital for covered services rendered to members, based on specified reimbursement rates.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Second Amendment_20140101_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,95%,95,,,,,,,Reimbursement Rate: 95% of the Hospital's billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,95%,95,,,,,,,Reimbursement Rate: 95% of the Hospital's billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF and DME",N/A,Billed Charges,Billed Charges,Y,85%,85,,,,,,,Reimbursement Rate: 85% of the Hospital's billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% or 50% of billed charges,100,,,,,,,100% of the Medicare Allowed Amount or 50% of billed charges for services without a Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Injectable medications,N/A,Billed Charges,Billed Charges,Y,85%,85,,,,,,,Generally paid according to 85% of the Hospital's billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Second Amendment_20140101_MP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Ohio Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Ohio Hospital Agreement to include Cincinnati Children's Hospital Medical Center as a provider in the network established by CareSource Kentucky for the CareSource Kentucky Just4MeTM Product on the Kentucky Exchange. The scope of the Agreement includes the reimbursement rates for covered services rendered by the Hospital and the filing deadlines, reimbursement process, and appeals process for claims submitted by the Hospital to Plan.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Ohio, Kentucky",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"1st day of January, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"1st day of January, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,95%,95%,,,,,,,Reimbursement Rate: 95% of the Hospital's billed charges.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,95%,95%,,,,,,,Reimbursement Rate: 95% of the Hospital's billed charges.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF, and DME",N/A,Billed Charges,Billed Charges,Y,85%,85%,,,,,,,Reimbursement Rate: 85% of the Hospital's billed charges.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% Medicare Allowed Amount or 50% of billed charges,100% or 50%,,,,,,,Covered Services that have not been assigned a Medicare Allowed Amount shall be paid at 50% of billed charges.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Injectable medications,N/A,Billed Charges,Billed Charges,Y,85%,85%,,,,,,,Injectable medications will generally be paid according to the 85% of the Hospital's billed charges.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Cleveland Clinic Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between the Parties involved. It covers various aspects such as indemnification, limitation of liability, dispute resolution, governing law, compliance with regulatory requirements, and contracting authority. The scope of the Agreement includes intellectual property protection, confidentiality, reimbursement, operational issues, and compliance with applicable laws and regulations.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"December 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Cleveland Clinic Provider Agreement_20171201.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"December 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Hospital,,General,Ohio Medicaid,Fee Schedule,,,107%,,,,,,,"For inpatient services, CareSource shall reimburse Provider at a rate of 107% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,Inpatient,,Y,107% of the relevant ODM rate schedule and reimbursement methodology,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Hospital,,General,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For outpatient services, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,Outpatient,,Y,100% of the relevant ODM rate schedule and reimbursement methodology,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Anesthesiology,Ohio Medicaid,Fee Schedule,,,105%,,,,,,,"For professional anesthesiology services, CareSource shall reimburse Provider at a rate of 105% of the relevant ODM rate schedule in effect on the date of service.",,,,,,,,,,,,General,,Y,105% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Radiology,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For professional radiology services, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule in effect on the date of service.",,,,,,,,,,,,General,,Y,100% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Laboratory,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For reference lab services, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,General,,Y,100% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Home Health,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For home care services, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,General,,Y,100% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Home Infusion,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For home infusion services the Parties will mutually agree on a time frame and methodology for reducing Provider's reimbursement for home infusion services to 100% of the relevant ODM rate schedule by December 1, 2017.",,,,,,,,,,,,General,,Y,"100% of the relevant ODM rate schedule by October 1, 2018",,,,,,,,,,,,,,,,,,,,,,,,
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Hospice,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For hospice services, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,General,,Y,100% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,DME,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,"For DME, CareSource shall reimburse Provider at a rate of 100% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,General,,Y,100% of the relevant ODM rate schedule,,,,,,,,,,,,,,,,,,,,,,,,
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Anesthesia,Per Diem,Per Diem,,,,,,,,,,"For anesthesia services, CareSource shall reimburse Provider at a rate of $26.00 per ASA unit.",,,,,,,,,,,,General,,N,,,,,,,,,,,,,,,,,,,,,,,,,
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Cleveland Clinic Provider Agreement_20171201.txt,,,,Professional,,Unpriced/Unlisted Codes,Billed Charges,Billed Charges,,,"60%, 50%, 45%",,,,,,,"For codes that are not priced by ODM, CareSource shall reimburse Provider 60% of billed charges for inpatient facility, 50% of billed charges for outpatient facility and 45% of billed charges for professional services.",,,,,,,,,,,,General,,Y,"60% of billed charges for inpatient facility, 50% of billed charges for outpatient facility and 45% of billed charges for professional services",,,,,,,,,,,,,,,,,,,,,,,,
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Cleveland Clinic Provider Agreement_20171201.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between the Parties involved, namely the Plan and the Hospital. The Agreement covers various aspects such as indemnification, limitation of liability, dispute resolution, compliance with HIPAA regulations, access to data, use of names, and the relationship between the Parties. The Agreement also outlines the termination provisions.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10.6.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10.6.15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"The Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for indirect medical education (IME), disproportional share (DSH) and outlier payments if applicable.",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,"Home Health, Hospice, SNF, and Dialysis",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"When combined with all other sources of payment, CareSource's Payment cannot exceed the Payment listed in this Medicare Addendum.",,,Reference Lab and DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"Agreement between CareSource and Community Health Network, Inc",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes the addition of a new exhibit related to the Healthy Indiana Plan Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Eighth Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Eighth Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Eighth Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Eighth Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,07-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Eighth Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Caresource Provider Agreement for Delegation,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to delegate responsibilities from the Sponsor to the Provider for the provision of services related to Qualified Health Plans. The scope of the Agreement includes compliance with applicable laws, regulations, and Health Insurance Exchange Rules, reporting obligations, access to books and records, and subcontracting requirements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,07-11-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Exchange Addendum.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""FIFTH AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND COMMUNITY HEALTH NETWORK, INC.""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes adding Federal Tax IDs to the Agreement, adding an exhibit for compensation schedules, clarifying that certain facilities are not in-network, and maintaining the terms and conditions of the original Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,FIFTH,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,350983617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1336119478,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-01-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Fifth Amendment_Adding TINs.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Community Health Network_Fifth Amendment_Adding TINs.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"April 1, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Fifth Amendment_Adding TINs.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Injectable medications will be paid according to the Medicare fee schedule in effect as of the date the services are rendered.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Fifth Amendment_Adding TINs.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Prevailing Indiana Medicaid Fee Schedule,Billed Charges,Y,Global fee based on 100% of the Prevailing Indiana Medicaid Fee Schedule,100%,,,,,,,Provider acknowledges CareSource shall reimburse the lesser of billed charges or a global fee based on 100% of the Prevailing Indiana Medicaid Fee Schedule.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Fifth Amendment_Adding TINs.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,Injectable medications will be paid according to the Medicare fee schedule in effect as of the date the services are rendered.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing Provider Agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes the addition of a new exhibit titled ""CareSource Indiana, Inc. CareSource Hoosier Choice Plan Compensation Schedule"" and the revision of the Affiliations Attachment. All other terms and conditions of the Agreement, including its exhibits and attachments, remain unchanged.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-0983617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,08-12-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"August 1st, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,Hospital,Inpatient,Facility Services,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,Hospital,Outpatient,Facility Services,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,Professional,N/A,Professional Services,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,Home Health/Hospice/SNF/Dialysis,N/A,"Home Health, Hospice, SNF, Dialysis",Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,Laboratory/DME,Reference Lab and DME,Lab and DME Services,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_First Amendment_Adding Hoosier Choice.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions for Provider's participation in Plan's Medicare Advantage, Dual-Eligible Special Needs Plan (D-SNP), and other Medicare product plans. The Agreement outlines the Provider's obligations, compliance with CMS Rules, oversight by Plan, accessibility and continuity of care, treatment plans for Covered Persons with complex medical conditions, and financial protections for Covered Persons. The Agreement's scope covers the provision of Covered Services to Covered Persons and the adherence to CMS Rules and Plan's contractual obligations with CMS.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the given context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,,,,Hospital,,Trach,Billed Charges,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,,,,Hospital,,Trach,Medicare Allowed Amount,Billed Charges,Y,Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_MA DSNP Deeming Letter_IN Timely Filing.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Ninth Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Ninth Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes the deletion and replacement of certain compensation schedules, the addition of new compensation schedules, and the clarification that facilities located within Hamilton and Marion County are not in-network or participating providers for the CareSource Indiana Marketplace Plan.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Ninth Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,6/21/22,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,,,,Hospital,Inpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,"Reimbursement calculated as sum of operating base rate and capital base rate multiplied by Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,,,,Hospital,Outpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,All Procedure Codes not covered by Medicare or Indiana Medicaid shall be non-covered except for Procedure Codes listed in Table 1.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,,,,Ambulatory Surgery Center,ASC,General,Medicare Allowed Amount,Fee Schedule,Y,135%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,,,,Home Health/Home Infusion,Home Health,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,,,,Hospice,Hospice,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,,,,Durable Medical Equipment,DME,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,Reimbursement is 75% of MSRP for codes manually priced.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Ninth Amendment.txt,,,,Physician/Provider Group/Ancillary,Physician Services,General,Medicare Allowed Amount,Fee Schedule,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Ninth Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions governing the provision of and payment for health services provided to covered persons under the CareSource Indiana, Inc. Medicaid Plan. The Agreement applies to providers who participate in the Plan's Medicaid Network and includes provisions related to claims submission, payment, timing, and compliance with applicable laws and regulations. The Agreement also specifies that Hamilton County, Indiana is the sole venue for any arbitration or legal proceedings related to the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Community Health Network_Second Amendment_Adding IN MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 9/8/16.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Indiana Medicaid DRG,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,Outliers and transfers reimbursed according to State Methodology,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,"Includes IME, DSH, and outlier payments if applicable",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,,,,"Home Health, Hospice, SNF, and Dialysis",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Second Amendment_Adding IN MCD.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,Injectable medications may be available through a specialty pharmacy benefits manager,,,Reference Lab and DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""SEVENTH AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND COMMUNITY HEALTH NETWORK, INC"".",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes the reimbursement of facility services, the exclusion of certain facilities from being considered in-network or participating providers, the definition of terms, the continuation of all other terms and conditions of the Agreement, and the prohibition of the provider from billing or seeking payment from covered individuals for covered services.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,1/21/2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,1/21/2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,1/21/2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Inpatient Facility Services,N/A,Medicare Allowed Amount,Billed Charges,Y,135% of the Medicare Allowed Amount,135%,,,,,,,"Inpatient Reimbursement includes operating base rate, capital base rate, DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Outpatient Facility Services,N/A,Medicare Allowed Amount,Billed Charges,Y,135% of the Medicare Allowed Amount,135%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Inpatient Rehabilitation,N/A,Medicare CMG Allowed Amount,Billed Charges,Y,135% of Medicare CMG Allowed Amount,135%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Professional Services,N/A,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,Hospital,"Home Health, Hospice, SNF, Dialysis",N/A,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,Hospital,"Reference Lab, DME, Radiology",N/A,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,Ambulatory Surgery Center,Ambulatory Surgery Center Services,N/A,Medicare Allowed Amount,Billed Charges,Y,135% of the Medicare Allowed Amount,135%,,,,,,,"Injectable medications paid at 120% of Medicare fee schedule, subject to change with notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Professional Urgent Care,N/A,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,Hospital,Anesthesia,N/A,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Seventh Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"Agreement between CareSource and Community Health Network, Inc.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a contractual relationship between CareSource and Community Health Network, Inc. The Agreement outlines the terms and conditions for the provision of Covered Services by Community Health Network, Inc. to Covered Persons under the CareSource Indiana Healthy Indiana Plan. The Agreement also includes compensation schedules and provisions regarding billing, collection, and reimbursement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Sixth Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 08/26/19.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Sixth Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Medicare,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will be paid according to the Medicare fee schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,General,Medicare,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for IME, DSH and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Outpatient,General,Medicare,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Outpatient Facility Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,Rehabilitation,Medicare CMG,Billed Charges,Y,100% of Medicare CMG Allowed Amount,100%,,,,,,,Inpatient Rehabilitation Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Outpatient,General,Indiana Medicaid,Billed Charges,Y,100% of the Indiana Medicaid Fee Schedule,100%,,,,,,,Outpatient Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,100% of the Indiana Medicaid DRG,100%,,,,,,,Inpatient Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,Rehabilitation,State Methodology,Billed Charges,Y,Inpatient Rehabilitation shall be reimbursed according to State Methodology,,,,,,,,Inpatient Rehabilitation Reimbursement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,General,Medicare,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,Inpatient and Outpatient Facility Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Inpatient,Rehabilitation,Medicare CMG,Billed Charges,Y,150% of Medicare CMG Allowed Amount,150%,,,,,,,Inpatient Rehabilitation Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Hospital,Outpatient,General,Medicare,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,"Professional Services, Home Health, Hospice, SNF, Dialysis, Reference Lab, DME, and Radiology Reimbursement Rate",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Sixth Amendment.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Medicare,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,Ambulatory Surgery Center Services Reimbursement Rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Tenth Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Community Health Network, Inc. The scope of the Agreement includes the addition of a new exhibit related to the Healthy Indiana Plan (HIP) and improving outcomes for substance use through targeted provider outreach.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Tenth Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Tenth,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Tenth Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Health Network_Tenth Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,08-02-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 8/2/2022.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Tenth Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,08-02-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to outline the terms and conditions between CareSource Indiana, Inc. and Community Health Network, Inc. It specifies that facilities located within Hamilton and Marion County are not considered in-network or participating providers for the CareSource Indiana Marketplace Plan. The Agreement also prohibits the provider from billing or seeking remuneration from covered persons for covered services, except for cost shares required by the plan or non-covered services. The Agreement's terms remain in full force and effect unless expressly amended.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,350983617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Health Network_Third and Fourth Amendments.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,12/20/17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,12/20/17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,"Inpatient Reimbursement includes operating base rate, capital base rate, DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Professional,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Home Health,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Hospice,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,SNF,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,SNF,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Dialysis,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,Dialysis,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Lab,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,Reference Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,DME,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the Medicare Allowed Amount,120%,,,,,,,,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Health Network_Third and Fourth Amendments.txt,,,,Pharmacy,,General,Medicare Fee Schedule,Billed Charges,Y,120% of the Medicare Fee Schedule,120%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,Injectable Medications,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The name of the Agreement is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement establishes the terms and conditions between the Group Practice and the Plan. It covers matters such as notice requirements, conflict resolution through arbitration, exceptions for seeking equitable remedies, governing law and venue, contracting authority, changes in law, compliance with regulatory requirements, assignment, non-exclusivity, and the entire agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Hamilton County, Indiana",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,"61-1276316 , 61-0978438 61-0703799",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2-17-2015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,,,,Professional Services,,Adult Covered Persons,Medicare Allowed Amount,Fee Schedule,,,125%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,125% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,,,,Professional Services,,Pediatric Covered Persons,Medicare Allowed Amount,Fee Schedule,,,135%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,135% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,,,,Injectable Medications,,Not Specified,Medicare Fee Schedule,Fee Schedule,,,110%,,,,,,,Except for those drugs that may be available through a specialty pharmacy benefits manager,,,,,,,,,,,,Not Specified,,Y,110% of the Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,,,,Services Not on Medicare Fee Schedule,,Not Specified,Billed Charges,Billed Charges,,,35%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,35% of billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_IN MP-ID C12324214AA.txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a comprehensive document that outlines the terms and conditions agreed upon by the Parties. It covers various aspects such as non-exclusivity, notice requirements, conflict resolution, and limitation of liability. The purpose of the Agreement is to establish a mutually beneficial relationship between the Parties and govern their interactions regarding the subject matter. It supersedes all other agreements and sets out the rights and obligations of each Party.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2/17/15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is January 1, 2015.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,,,,Professional Services,,,130% of the Medicare Allowed Amount,Fee Schedule,,,130%,,,,,,,,,,,,,,,,,,,Not Specified,Not Specified,Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,,,,Professional Services,,,140% of the Medicare Allowed Amount,Fee Schedule,,,140%,,,,,,,,,,,,,,,,,,,Not Specified,"Maternal Fetal Medicine, Oncology, Neurosurgery, Orthopaedics",Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Medical Associates_20150217_Dually Executed_KY MP-ID C12297981AA.txt,,,,Professional Services,,,110% of the Medicare Fee Schedule,Fee Schedule,,,110%,,,,,,,Injectable medications,,,,,,,,,,,,Not Specified,Not Specified,Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions for Provider's participation in Plan's Medicare Advantage Plan. It outlines the Provider's obligations, including compliance with CMS Rules and allowing audits by HHS and the Comptroller General. The Agreement also addresses the accessibility and continuity of care for Covered Persons and the financial protections for Dual Eligible Members.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Physicians of Indiana Inc.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Physicians of Indiana Inc.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Physicians of Indiana Inc.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Community Physicians of Indiana Inc.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the given context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Community Physicians of Indiana Inc.txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,100% of the Medicare allowed amount,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,,,,Hospital,Inpatient,Trach,Medicare Allowed Amount,Billed Charges,Y,Billed Charges,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Community Physicians of Indiana Inc.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Hospital Agreement between CareSource and Dayton Children's Hospital. The scope of the Agreement includes the reimbursement rates for medically necessary covered services provided by the Hospital to members, as well as the terms and conditions governing the agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-0672132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2022.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Inpatient,Facility Services,Billed Charges,Billed Charges,Y,25% of Hospital's total Eligible Billed Charges,25%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,Facility Services,Medicare,Fee Schedule,Y,150% of the Medicare allowed amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,Professional Services,Medicare,Fee Schedule,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,Reference Lab / DME,Medicare,Fee Schedule,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,"Home Health, Hospice, Dialysis, SNF",Medicare,Fee Schedule,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,Specialty and Non-Specialty Drugs and Services,Medicare,Fee Schedule,Y,100% of the Medicare allowed amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,Hospital,Outpatient,Drugs not otherwise specified,AWP,Billed Charges,Y,AWP minus 15%,AWP minus 15%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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DCH_Tenth Amendment_20220401_OH Marketplace A.4_20220510_Final.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process between CareSource and Provider. It specifies that if a dispute is not resolved within a certain timeframe, it can be referred to binding arbitration. The Agreement also includes provisions for indemnification and limitation of liability. Additionally, it states that the Agreement may be subject to review and approval by state and federal agencies.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,11-22-16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Hospital,Inpatient,HAF Eligible Inpatient Facility Services,Medicaid Fee Schedule with the HAF adjustment factors applied,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Hospital,Outpatient,HAF Eligible Outpatient Facility,Medicaid Fee Schedule with the HAF adjustment factors applied,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Hospital,Inpatient,Non-Eligible HAF Hospital Inpatient,Medicare Fee Schedule,Fee Schedule,N,"If Medicare Fee Schedule does not exist, 130% of the Medicaid Fee Schedule shall apply",100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Hospital,Outpatient,Non-Eligible HAF Hospital Outpatient,Medicare Fee Schedule,Fee Schedule,N,"If Medicare Fee Schedule does not exist, 130% of the Medicaid Fee Schedule shall apply",100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Hospital,Outpatient,Reference Laboratory,Medicare Fee Schedule,Fee Schedule,N,"If Medicare Fee Schedule does not exist, 130% of the Medicaid Fee Schedule shall apply",100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Other Services,Home Health,Home Health,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Other Services,Hospice,Hospice,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Other Services,Ancillary Services,Ancillary Services,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Other Services,DME,DME,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Physicians,Office,Physicians,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,For Covered Services rendered by physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,Physicians,Office,Non-physicians,Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,For Covered Services rendered by non-physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Deaconess Health System Dually Executed 11.22.16 IN CareSource Mdcd Agreement.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,UzeWBR0pv60xsM-0vEAF7w,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between CareSource and the Provider. It outlines the rights and obligations of both parties and covers areas such as covered services, termination of coverage, indemnification, limitation of liability, dispute resolution, and governing law. The Agreement applies to the provision of healthcare services and is intended to benefit covered persons.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-2643952,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,58-2643952,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,58-2643952,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170623,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,,,,Physician/Provider/Group,,Not Specified,100% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,,,,Non-Physician,,Not Specified,90% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,,Provider's billed charges,90%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Pediatrics PC_20170623_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,East Georgia Medical Center National Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between the Parties involved. It covers various aspects such as arbitration, governing law and venue, contracting authority, change in law, compliance with regulatory requirements, assignment, limitation of liability, and dispute resolution. The Agreement aims to define the rights, obligations, and limitations of the Parties in a clear and comprehensive manner.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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East Georgia Regional Medical Center_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-10-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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East Georgia Regional Medical Center_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,Billed Charges or Allowable,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,Hospital,Outpatient,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,Allowable billed charges,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,Hospital,Professional Services,General,Medicare Allowed Amount,Fee Schedule,Y,Allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,Hospital,"Home Health, Hospice, SNF, Dialysis",General,Medicare Allowed Amount,Fee Schedule,Y,Allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,Hospital,Reference Lab and DME,General,Medicare Allowed Amount,Fee Schedule,Y,Allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and East Georgia Regional Medical Center, LLC. The amendment allows the provider to offer Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan and participate in CareSource's Qualified Health Plan Network. The scope of the Agreement includes the addition of specific provisions and compensation schedules for the Qualified Health Plan in Georgia.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-21090713,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10-01-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 10-1-19.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,180% of the Medicare Allowed Amount,180%,,,,,,,"The Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for indirect medical education (IME), disproportional share (DSH, Capital and Operating), Uncompensated Care and outlier payments if applicable.",,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,180% of the Medicare Allowed Amount,180%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,,,,SNF,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,,,,Dialysis,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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East Georgia Regional Medical Center_First Amendment_QHP.txt,,,,Hospital,,Facility Services,Billed Charges,Billed Charges,Y,40% of the Providers Billed Charges,40%,,,,,,,If there is not a Medicare Allowed Amount dictated in the Medicare Fee Schedule for Medically Necessary Covered Services rendered to Covered Persons by Provider,,,Other,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between CareSource and Provider for the provision of Covered Services to Members. It includes provisions for termination, appeals procedures, and the non-exclusive nature of the Agreement. The Agreement also specifies that Provider is not limited in acting within the lawful scope of practice and has the right to advocate on behalf of Members. Additionally, it addresses requirements related to pre-service consultation, access to records, cultural competency, marketing materials, newborn notification, eligibility verification, and compliance with federal regulations.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,11-09-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 11/09/2021.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",,,,Professional Services,N/A,N/A,140% of the Medicare Allowed Amount,Billed Charges,Y,140%,140%,,,,,,,"If there is not a Medicare Allowed Amount dictated in the Medicare Fee Schedule for Medically Necessary Covered Services rendered to Covered Persons by Provider, then Provider shall accept as payment-in-full 100% of the CareSource fee schedule for such Covered Services, which shall be based on Resource-Based Relative Value Units (RBRVU) reimbursement methodology.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",,,,Professional Services,N/A,N/A,100% of the CareSource fee schedule,Fee Schedule,Y,100%,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"East Georgia Women's Center PC_20211109_ Second Amendment adding GA, Marketplace(Just4Me)_NSSplaceholder5.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Eleventh Amendment_MetroHealth System_20140601.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Eleventh Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Eleventh Amendment_MetroHealth System_20140601.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions for the Value-Based Reimbursement (VBR) Program between the Plan and the Hospital. It covers the provision of services, data sharing and collaboration, payment and audit procedures, and the development of additional VBR programs. The purpose of the Agreement is to establish a collaborative relationship between the parties and promote improved quality and health outcomes through innovative payment models.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Eleventh Amendment_MetroHealth System_20140601.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Eleventh Amendment_MetroHealth System_20140601.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Eleventh Amendment_MetroHealth System_20140601.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,06-01-2015,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Hospital,,General,Ohio Medicaid DRG/PPS base rate,Billed Charges,Y,115% or Allowable Billed Charges,115%,,,,,,,"Inpatient Services reimbursement calculation includes base rate, IME, DRG weight, adjustments for capital add-on and outlier payments",,,,,,,,,,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Hospital,,General,Ohio Medicaid DRG/PPS base rate,Billed Charges,Y,112% or Allowable Billed Charges,112%,,,,,,,"Inpatient Services reimbursement calculation includes base rate, IME, DRG weight, adjustments for capital add-on and outlier payments",,,,,,,,,,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Hospital,,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,115% or Allowable Billed Charges,115%,,,,,,,Outpatient Services reimbursement,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Hospital,,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,112% or Allowable Billed Charges,112%,,,,,,,Outpatient Services reimbursement,,,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Professional,,Primary Care,Ohio Medicaid Fee Schedule,Billed Charges,Y,105% or Allowable Billed Charges,105%,,,,,,,"Reimbursement for primary and specialty physicians, and non-physician professionals",,,,,,,,,,,,Office,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,Hospital,,General,Medicare per diem,Per Diem,Y,75% or Allowable Billed Charges,75%,,,,,,,Skilled nursing facility Covered Services reimbursement,,,,,,,,,,,,Skilled Nursing Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Eleventh Amendment_MetroHealth System_20140601.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions for the provision of Covered Services by Emory Healthcare Inc. and its Affiliates to CareSource Members. The Agreement outlines the limitations and requirements for Primary Care Physicians and OB/GYN physicians, as well as the reimbursement process for Certified Nurse Midwives. It also includes provisions for the participation of Emory Providers in CareSource's network for Behavioral Health services. The Agreement remains in full force and effect, except as expressly amended.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-1966795,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is April 1, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Emory Healthcare Inc_20190403_ First Amendment_.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions for the provision of Covered Services by the Provider. It outlines the rights and obligations of both parties and includes provisions for termination, arbitration, compliance with regulatory requirements, and assignment. The Agreement is binding upon the respective legal successors and assignees of the Parties and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,07-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Hospital,,,CHAMPUS DRG Grouper,Fee Schedule,,,,,,,,,,"Minimum based on the then-current year CHAMPUS DRG Grouper used by State of Georgia for Medicaid claims payment. The then-current year DRG and relative weights assigned by this CHAMPUS DRG Grouper shall apply. The then-current year Medicaid base rate will be multiplied by DRG relative weights and then the current year Medicaid add-ons will be applied, including but not limited to direct graduate medical education and capital for each Emory Hospital.",,,,,,,,,,,,Inpatient,Trach,Y,DRG billed by Hospital in Box 78,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Hospital,,,Medicaid fee schedule,Fee Schedule,,,,,,,,,,All outpatient clinical diagnostic laboratory services and injectable drugs billed by the Emory Hospitals on a UB-92 will be paid by the then-current year Medicaid fee schedule.,,,,,,,,,,,,Outpatient,Clinical Diagnostic Laboratory Services and Injectable Drugs,Y,Hospital specific Outpatient Cost to Charge Ratio (CCR),,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Hospital,,,Percent of Billed Charges,Billed Charges,,,,,,,,,,"To simulate the current Medicaid outpatient payment reimbursement rates for all clinical diagnostic laboratory services and injectable drugs not noted in the above Medicaid fee schedule and all other outpatient services, Emory Hospitals will be reimbursed at a percent of billed charges as defined by the then current hospital specific Outpatient Cost to Charge Ratio (CCR) as determined by the most recent audited cost reports by Medicaid.",,,,,,,,,,,,Outpatient,Other Outpatient Services,Y,Hospital specific Outpatient Cost to Charge Ratio (CCR),,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Ambulatory Surgery Center,,,Georgia Medicaid Ambulatory Surgical Center (ASC) Payment Rate by Group,Fee Schedule,,,,,,,,,,Free-Standing Emory Clinic Ambulatory Surgery Centers will be paid per the then-current Georgia Medicaid Ambulatory Surgical Center (ASC) Payment Rate by Group (Atlanta 03).,,,,,,,,,,,,Outpatient,Surgery,N,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Physician,,,Georgia Medicaid Maximum Allowable Payment,Fee Schedule,,,112%,,,,,,,"Services for all primary care physicians defined as general medicine, internal medicine, pediatric and family practice will be paid at 112% of the then-current year Georgia Medicaid Maximum Allowable Payment.",,,,,,,,,,,,Office,Primary Care,N,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Physician,,,Georgia Medicaid Maximum Allowable Payment,Fee Schedule,,,110%,,,,,,,"All other specialty physicians and all other professional services, including but not limited to Anesthesiology, and the Emory Clinic Cardiac Catheterization Laboratories will be paid at 110% of the then-current year Georgia Medicaid Maximum Allowable Payments.",,,,,,,,,,,,Office,Specialty Physicians,N,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Physician,,,Georgia Medicaid Maximum Allowable Payment,Fee Schedule,,,150%,,,,,,,Services for all pediatric physicians will be paid at 150% of the then-current year Georgia Medicaid Maximum Allowable Payments.,,,,,,,,,,,,Office,Pediatric,N,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,Physician,,,Unlisted Codes,Billed Charges,,,60%,,,,,,,Any unlisted codes or codes not addressed by the Georgia Medicaid Maximum Allowable Payments shall be reimbursed at 60% of billed charges.,,,,,,,,,,,,Office,Unlisted Codes,N,,,,,,,,,,,,,,,,,,,,,,,,,
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"Emory University Inc, dba Emory University Hospital_20170701_ Dually Executed Agreement.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Quality Rewards Addendum to the CareSource Provider Agreement. It allows Community Physicians of IN Inc. to participate in CareSource's Quality Rewards Program, which aims to improve the quality and efficiency of healthcare services while reducing costs. The Agreement outlines the terms and conditions of Provider's participation in the program.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Executed-Community QR.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Executed-Community QR.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-08-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,12/31/2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Executed-Community QR.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed-Community QR.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed-Community QR.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed-Community QR.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed-Community QR.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C20840883AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND FRANCISCAN ALLIANCE, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Franciscan Alliance, Inc. The scope of the Agreement includes the deletion and replacement of certain exhibits related to plan compensation schedules for Indiana Medicaid services. All other terms and conditions of the Agreement remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,1st,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is February 1st, 2023.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,115%,115%,,,,,,,"HAF adjustment factors applied, plus Outliers",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Laboratory,Reference Laboratory,Pathology,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,Hospital-based reference laboratory services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Home Health,Home Health,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospice,Hospice,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Ancillary Services,Ancillary Services,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,DME,DME,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Physician,Office,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,For services rendered by physicians and non-physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospital,Inpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid DRG- APR or LOC methodology,115%,,,,,,,"HAF adjustment factors applied, includes IME, DSH, and outlier payments if applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospital,Outpatient,General,Medicaid Fee Schedule,Billed Charges,Y,115% of the Medicaid Fee Schedule,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Professional Services,Office,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Home Health,Home Health,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Hospice,Hospice,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,SNF,SNF,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Dialysis,Dialysis,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,Laboratory,Reference Lab,Pathology,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,DME,DME,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Executed_FA 1st_MCD Amendment-ID C20840883AA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a provider agreement between CareSource and Fairfield Medical Center. The Agreement outlines the terms and conditions for reimbursement and compensation for medically necessary covered services rendered by the Hospital to members. The scope of the Agreement includes inpatient and outpatient services, as well as the reimbursement rates and transfer policy.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-0645626,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,,,,Hospital,Inpatient,General,Ohio Medicaid DRG,Billed Charges,N,,102%,,,,,,,102% of the Ohio Medicaid DRG (based on Hospital's current ODJFS payment rate).,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,,,,Hospital,Outpatient,General,Ohio Medicaid fee schedule,Fee Schedule,N,,101%,,,,,,,101% of the current Ohio Medicaid fee schedule.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center Third Amendment_20180101.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Fairfield Medical Center. The amendment adds Just4Me Reimbursement to the agreement. The scope of the Agreement remains the same, with all other terms remaining in full effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"April 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,,,,Hospital,Inpatient,General,Blended Medicare reimbursement rate,Billed Charges,Y,Blended Facility Rate 130%,130%,,,,,,,"Reimbursement for Covered Services to Members, adjustments reviewed quarterly",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,,,,Professional,Outpatient,General,Blended Medicare reimbursement rate,Billed Charges,Y,Blended Professional Rate 118%,118%,,,,,,,"Reimbursement for Covered Services to Members, adjustments reviewed quarterly",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,,,,Hospital,Outpatient,General,Injectable medications rate,Billed Charges,Y,100% of the Medicare Fee Schedule,100%,,,,,,,For Injectable medications excluding specialty pharmacy benefits,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fairfield Medical Center_20140311_Just4Me Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,DAHP Hospital and Employed Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing Hospital and Employed Provider Agreement between Dayton Area Health Plan and Children's Medical Center. The scope of the Agreement includes reimbursement and compensation for inpatient and outpatient services, clinic reimbursement, home health services, IV therapy, and professional services.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1, 2006",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"April 1, 2006",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,04-05-2006,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,Inpatient,N/A,Ohio Medicaid Fee Schedule,Fee Schedule,Y,106%,106%,,,,,,,Reimbursed at the lesser of 106% of the prevailing Ohio Medicaid Fee Schedule or 100% of the Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,Inpatient,N/A,Hospital's allowable billed charges,Billed Charges,Y,100%,100%,,,,,,,Reimbursed at the lesser of 106% of the prevailing Ohio Medicaid Fee Schedule or 100% of the Hospital's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,Outpatient,N/A,Ohio Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,Reimbursed at 100% of the prevailing Ohio Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,Clinic,N/A,State methodology,Fee Schedule,N,,N/A,,,,,,,Clinic Reimbursement per State methodology,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,Ancillary Service Home Health,N/A,Ohio Medicaid Fee Schedule,Fee Schedule,Y,100%,100%,,,,,,,Lessor of ordinary and customary fee or 100% of the prevailing Ohio Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Hospital,IV Therapy,N/A,Per Infusion Schedule,Fee Schedule,N,,N/A,,,,,,,IV Therapy per Infusion Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Professional (Physician),Physician Services,N/A,CareSource's fee schedule,Fee Schedule,Y,105%,105%,,,,,,,The lesser of 100% of allowable billed charges or CareSource's fee schedule for such services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Professional (Physician),Physician Services,N/A,Hospital's allowable billed charges,Billed Charges,Y,100%,100%,,,,,,,The lesser of 100% of allowable billed charges or CareSource's fee schedule for such services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Fifth_Amendment_Children_s_Medical_Center_A120060405.txt,,,,Professional (Non-Physician),Non-Physician Covered Services,N/A,Ohio Medicaid fee schedule,Fee Schedule,N,,100%,,,,,,,Reimbursed at 100% of the prevailing Ohio Medicaid fee schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Final Executed 12-8-2020.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Final Executed 12-8-2020.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Final Executed 12-8-2020.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement establishes the terms and conditions between CareSource Network Partners LLC and Atlanta Women's Health Group, P.C. It covers the provision of healthcare services to covered persons under CareSource Medicare Advantage Plans. The Agreement includes provisions for notice, amendment, conflict resolution, and compliance with regulatory requirements. It also addresses contracting authority, change in law, assignment, non-exclusivity, and enforceability. The Agreement is the entire agreement between the parties and supersedes all other agreements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-2422542,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 23, 2021",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is December 8, 2020.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,,,,Professional,,,155% of the Medicare Allowed Amount,Fee Schedule,,,155%,,,,,,,Professional Services Reimbursement Rate,,,,,,,,,,,,Not Specified,Not Specified,Y,155%,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,,,,Professional,,,100% of the CareSource fee schedule,Fee Schedule,,,100%,,,,,,,For services without a Medicare Allowed Amount,,,,,,,,,,,,Not Specified,Not Specified,Y,100% of the CareSource fee schedule,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,,,,Physician/Provider/Group,,,105% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,,105%,,,,,,,Physician Covered Services,,,,,,,,,,,,Not Specified,Not Specified,Y,105%,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,,,,Physician/Provider/Group,,,90% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,,,90%,,,,,,,Non-physician Covered Services,,,,,,,,,,,,Not Specified,Not Specified,Y,90%,,,,,,,,,,,,,,,,,,,,,,,,
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Final Executed 12-8-2020.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Letter of Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish a contractual relationship between Caresource (Health Plan) and Floyd Healthcare Management, Inc. (Hospital) for the provision of healthcare services to individuals enrolled in Georgia's Medicaid and CHIP programs. The Agreement outlines the services to be provided by the Hospital, the reimbursement rates, and the notification and authorization requirements. It also includes provisions for underpayments, denials, termination, and dispute resolution.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"February 2, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"March 1, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"February 2, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Inpatient,Acute Care,Medicaid DRG base payment amount,Billed Charges,Y,105% of Hospital's then-current Medicaid DRG base payment amount,105%,,,,,,,Hospital's then current Medicaid capital add-on rate shall then be added.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Emergency Room,"CPT code 99281, 99282, 99283, 99284, 99285, 99291, 99292",Billed Charges,N,,105%,,,,,,,"Level 1 and 2 have specific case rates, Levels 3, 4, 5, and critical care are paid at 105% of Hospital's IOR with exceptions.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Clinical Diagnostic Laboratory,Georgia Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,100% of the then-current published Georgia Medicaid Fee Schedule or 60% of the then current Medicare fee schedule for codes with no defined fee.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Other Outpatient Services,Hospital's IOR,Billed Charges,N,,105%,,,,,,,"Includes radiology, injections, infusions, observation, surgery, clinic fees, medications, etc.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Hospice,Per Diem rates for Hospice,Per Diem,N,,105%,,,,,,,105% of the then current per diem rates for Hospice as published by the Department of Community Health for Hospital.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Ambulance Services,Georgia Medicaid for Hospital,Fee Schedule,N,,105%,,,,,,,Ambulance Services shall be reimbursed at 105% of the then current fee schedule as determined by Georgia Medicaid for Hospital.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,Hospital,Outpatient,Outpatient Rehabilitation,Hospital's IOR,Billed Charges,N,,105%,,,,,,,Floyd Outpatient Rehabilitation Center services shall be reimbursed at 105% of Hospital's IOR as outlined above.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Management Inc_20170426_Dually Executed LOA.txt,,,,,,,,,,,,N/A,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,Emergency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Facilities Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement establishes the terms and conditions for the provision of Health Services at the listed facilities. It covers matters such as contracting authority, change in law, compliance with regulatory requirements, assignment, non-exclusivity, and dispute resolution. The Agreement is binding upon the Parties and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-1973570,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"Dec 20, 2021",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is December 20, 2021.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,Trach,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,"The Medicare Allowed Amount for Inpatient Services shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for indirect medical education (IME), disproportional share (DSH) and outlier payments if applicable.",,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,65% of the Medicare Allowed Amount,65%,,,,,,,,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare IRF Methodology Allowed Amount,Billed Charges,Y,100% of the Medicare IRF Methodology Allowed Amount,100%,,,,,,,,,,Rehabilitation Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,Hospice Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare IPF Methodology Allowed Amount,Billed Charges,Y,100% of the Medicare IPF Methodology Allowed Amount,100%,,,,,,,,,,Behavioral Health Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,Ambulance Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,Hospital,,General,Per Diem rate as set forth in the rate letter issued by CMS,Per Diem,Y,100% of Per Diem rate as set forth in the rate letter issued by CMS,100%,,,,,,,,,,Critical Access Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Floyd Healthcare Mngt Inc_20211220_Base Facilities Agreement.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract Dually Ex-IN MP-ID C13357695AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between Plan and Group Practice. It covers various aspects such as indemnification, limitation of liability, dispute resolution, compliance with regulatory requirements, assignment, and notice. The Agreement is binding upon the Parties and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,45-2067348,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,03-08-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20160308,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicare Allowed Amount,115%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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FMMG LLC_20160308_Base Contract Dually Ex-IN MP-ID C13357695AA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Franciscan Alliance, Inc_2.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND FRANCISCAN ALLIANCE, INC.""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Franciscan Alliance, Inc_2.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Franciscan Alliance, Inc. The scope of the Agreement includes the deletion and replacement of certain exhibits related to plan compensation schedules for Indiana Medicaid services. All other terms and conditions of the Agreement remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Franciscan Alliance, Inc_2.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Franciscan Alliance, Inc_2.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is February 1st, 2023.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,115%,115%,,,,,,,"Includes HAF adjustment factors applied, as applicable, plus Outliers. Outliers are defined as cases where the days for a length of stay exceed the Day High Trim of the current Indiana Medicaid DRG schedule, or the total hospital allowable billed charges exceed the Charge High Trim of the current Indiana Medicaid DRG schedule. Reimbursement shall be reimbursed according to State Methodology.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Franciscan Alliance, Inc_2.txt",,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,"Includes HAF adjustment factors applied, as applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Laboratory,Reference Laboratory,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,For hospital-based reference laboratory services.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Home Health,Home Health,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Hospice,Hospice,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_2.txt",,,,Ancillary Services,Ancillary Services,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_2.txt",,,,DME,DME,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_2.txt",,,,Physician,Office,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,For Covered Services rendered by physicians and non-physicians. Injectable medications will generally be at 115% of the Indiana Medicaid Fee Schedule.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Hospital,Inpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid DRG- APR or LOC methodology,115%,,,,,,,"Includes HAF adjustment factors applied. Calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Hospital,Outpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid Fee Schedule,115%,,,,,,,Includes HAF adjustment factors applied.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Professional Services,Office,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Home Health,Home Health,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_2.txt",,,,Hospice,Hospice,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_2.txt",,,,SNF,SNF,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Dialysis,Dialysis,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,Laboratory,Reference Lab,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,DME,DME,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_2.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions for the provider's participation in the Plan's Medicare Advantage Plan. It covers the compliance with CMS Rules, oversight of covered services, accessibility and continuity of care, establishment of treatment plans for covered persons with complex medical conditions, and financial protections for covered persons. The Agreement's scope includes the provider's obligations, the rights of CMS to audit and inspect provider records, and the provider's obligation to continue providing covered services in the event of Plan's insolvency or termination of the agreement with CMS.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"April 1st, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161027,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",,,,Hospital,Inpatient,Trach,Medicare,Billed Charges,Y,Medicare Allowed Amount,100%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",,,,Hospital,Inpatient,Trach,Medicare,Billed Charges,Y,Medicare Allowed Amount,100%,,,,,,,D-SNP Covered Persons have no cost share obligations,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
"Franciscan Alliance, Inc_20161027_National Agreement Template.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND FRANCISCAN ALLIANCE, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Franciscan Alliance, Inc. The scope of the Agreement includes the deletion and replacement of certain exhibits related to plan compensation schedules for Indiana Medicaid programs. The Agreement also states that all other terms and conditions of the original Agreement will remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,1st,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is February 1st, 2023.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,115%,115%,,,,,,,"HAF adjustment factors applied, plus Outliers",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Laboratory,Reference Laboratory,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,Hospital-based reference laboratory services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Home Health,Home Health,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospice,Hospice,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Ancillary Services,Ancillary Services,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,DME,DME,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Physician,Office,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,For services rendered by physicians and non-physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospital,Inpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid DRG- APR or LOC methodology,115%,,,,,,,"HAF Eligible with adjustments for IME, DSH, and outlier payments if applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospital,Outpatient,General,Medicaid Fee Schedule,Billed Charges,Y,115% of the Medicaid Fee Schedule,115%,,,,,,,HAF Eligible,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Hospital,Inpatient/Outpatient,General,Medicare Fee Schedule,Billed Charges,Y,115% of the Medicare Fee Schedule,115%,,,,,,,Non-Eligible HAF Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Professional Services,Office,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicare Allowed Amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Home Health/Hospice/SNF/Dialysis,Various,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicare Allowed Amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,Reference Lab/DME,Reference Lab/DME,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicare Allowed Amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Health-Executed_FA 1st_MCD Amendment (3).txt,,,,,,,,,,,,N/A,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND FRANCISCAN ALLIANCE, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Franciscan Alliance, Inc. The scope of the Agreement includes the deletion and replacement of certain exhibits related to plan compensation schedules for Indiana Medicaid services. All other terms and conditions of the Agreement remain in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,1st,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is February 1st, 2023.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,02-01-2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,115%,115%,,,,,,,"HAF adjustment factors applied, plus Outliers",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Laboratory,Outpatient,Reference Laboratory,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,Hospital-based reference laboratory services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Home Health,Home,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospice,Home,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Ancillary Services,Various,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,DME,Various,Durable Medical Equipment,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Physician,Office,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,115%,115%,,,,,,,For services rendered by physicians and non-physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospital,Inpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid DRG- APR or LOC methodology,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospital,Outpatient,General,Medicare Allowed Amount,Billed Charges,Y,115% of the Medicaid Fee Schedule,115%,,,,,,,HAF adjustment factors applied,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Professional Services,Office,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Home Health,Home,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Hospice,Home,General,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,SNF,Facility,Skilled Nursing Facility,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Dialysis,Facility,Dialysis,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,Laboratory,Outpatient,Reference Laboratory,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,DME,Various,Durable Medical Equipment,Medicare Allowed Amount,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Franciscan Healthy Lafayette Central_Executed_FA 1st_MCD Amendment (4).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if necessary. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,GA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,,,,Professional,,,120% of the Medicare Allowed Amount,Fee Schedule,,,,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,Not Specified,Yes,Provider's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,,,,Professional,,,140% of the Medicare Allowed Amount,Fee Schedule,,,,,,,,,,"If there is not a Medicare Allowed Amount dictated in the Medicare Fee Schedule for Medically Necessary Covered Services rendered to Covered Persons by Provider, then Provider shall accept as payment-in-full 100% of the CareSource fee schedule for such Covered Services, which shall be based on Resource-Based Relative Value Units (RBRVU) reimbursement methodology. Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,Not Specified,Yes,Provider's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Yes,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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GA - Propath Services LLC_ Base Agreement_GA MCD_MP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource and Genesis Medical Group LLC. The Agreement outlines the terms and conditions for reimbursement of medically necessary covered services provided by the Provider or Group Practice Providers to Members. The Agreement also specifies the payment rates and policies, including the acceptance of payment in full based on the lesser of the Provider's billed charges or a percentage of the Medicare allowed amount. The Agreement remains in full force and effect, except for the amendments made in this First Amendment.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,26-3428410,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Genesis Medical Group_First Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Genesis Medical Group_First Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,,,,Not Specified,Not Specified,Not Specified,130% of the Medicare allowed amount,Fee Schedule,Y,130%,130%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider or by Group Practice Providers,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Genesis Medical Group_First Amendment_QHP.txt,,,,Not Specified,Not Specified,Not Specified,50% of the Provider's allowable billed charges,Billed Charges,Y,50%,50%,,,,,,,Unlisted Procedures: Covered services not included in the Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between CareSource Network Partners LLC and its Affiliates, and the Provider. The Agreement outlines the process for resolving disputes, including the use of arbitration if necessary. It also addresses the governing law and venue for any disputes. Additionally, the Agreement states that any changes required by law or regulatory agencies will be incorporated into the Agreement. The Agreement is binding upon the Parties and may not be assigned without consent. It is non-exclusive and supersedes any previous agreements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-09-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,,,,Hospital,,,Allowable,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Caresource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and Grady Memorial Hospital Corporation, d/b/a Grady Health System. The amendment allows Provider to provide Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan and participate in CareSource's Qualified Health Plan Network. The scope of the Agreement includes the addition of specific provisions and compensation schedules for the Qualified Health Plan in Georgia.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,262037695,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,First Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,160% of the Medicare Allowed Amount,160%,,,,,,,"The Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for indirect medical education (IME), disproportional share (DSH) and outlier payments if applicable.",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,160% of the Medicare Allowed Amount,160%,,,,,,,,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,160% of the Medicare Allowed Amount,160%,,,,,,,,,,"Home Health, Hospice, SNF, and Dialysis",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,160% of the Medicare Allowed Amount,160%,,,,,,,,,,Reference Lab and DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,CareSource fee schedule,Fee Schedule,Y,100% of the CareSource fee schedule,100%,,,,,,,"If there is not a Medicare Allowed Amount dictated in the Medicare Fee Schedule for Medically Necessary Covered Services rendered to Covered Persons by Provider, then Provider shall accept as payment-in-full 100% of the CareSource fee schedule for such Covered Services, which shall be based on Resource-Based Relative Value Units (RBRVU) reimbursement methodology.",,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Grady Memorial Hospital_First Amendment_QHP.txt,,,,Hospital,,N/A,Medicare Fee Schedule,Billed Charges,Y,100% according to the Medicare Fee Schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Injectable medications,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_01252019_Opt Out Email.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_01252019_Opt Out Email.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Health One Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_01252019_Opt Out Email.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to auto amend provider's agreements unless they contact CareSource. It specifically pertains to providers under the Health One network who have opted in to CareSource. The Agreement allows providers to participate in the VA Patient Centered Community Care Program (PCCC) administered through TriWest. CareSource is not administering or paying claims, but rather utilizing the CareSource network for this program.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_01252019_Opt Out Email.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_01252019_Opt Out Email.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_01252019_Opt Out Email.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_01252019_Opt Out Email.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is January 23, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_01252019_Opt Out Email.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_01252019_Opt Out Email.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The name of the Agreement is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_20170525_Dually Executed.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement outlines the indemnification and limitation of liability between CareSource and the Provider. It also includes provisions for dispute resolution and governing law. The Agreement is binding upon the Parties and supersedes all other agreements regarding the subject matter.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hamilton Medical Center_20170525_Dually Executed.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hamilton Medical Center_20170525_Dually Executed.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is April 24, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid DRG,Billed Charges,,,108%,,,,,,,"For Medically Necessary Covered Services rendered to Covered Persons by Provider in accordance with the terms of this Agreement, Provider shall accept as payment in full the following",,,,,,,,,,,,Inpatient,Trach,Y,108% of Provider's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Billed Charges,,,108%,,,,,,,N/A,,,,,,,,,,,,Outpatient,N/A,Y,108% of Provider's allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,Covered Services provided at a hospital based reference laboratory will be reimbursed at 100% of the Georgia Medicaid Fee Schedule.,,,,,,,,,,,,N/A,Reference Laboratory,N,N/A,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,108%,,,,,,,N/A,,,,,,,,,,,,N/A,Home Health,N,N/A,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,108%,,,,,,,N/A,,,,,,,,,,,,N/A,Hospice,N,N/A,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Physician,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,108%,,,,,,,For Covered Services rendered by physicians,,,,,,,,,,,,N/A,Physicians,N,N/A,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,Physician,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,80%,,,,,,,For Covered Services rendered by non-physicians,,,,,,,,,,,,N/A,Non-physicians,N,N/A,,,,,,,,,,,,,,,,,,,,,,,,
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Hamilton Medical Center_20170525_Dually Executed.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as the option for binding arbitration if disputes are not resolved. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-2234927,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,8-16-17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is July 1, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Primary Care Physicians,N/A,Including mid-level practitioners,110% of the prevailing Georgia (GA) Medicaid Schedule of Maximum Allowable Payments Physician fee schedule,Fee Schedule,Y,110%,110%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Obstetrics/Gynecology Specialists,N/A,Including mid-level practitioners,115% of the prevailing Georgia (GA) Medicaid Schedule of Maximum Allowable Payments Physician fee schedule,Fee Schedule,Y,115%,115%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Non-Obstetrics/Gynecology Specialists,N/A,Including mid-level practitioners,110% of the prevailing Georgia (GA) Medicaid Schedule of Maximum Allowable Payments Physician fee schedule,Fee Schedule,Y,110%,110%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Drugs & Biologicals,Injectable Drugs,N/A,105% of the prevailing Georgia (GA) Medicaid Schedule of Maximum Allowable - Injectable Drugs fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Laboratory Services,N/A,N/A,105% of the prevailing Georgia (GA) Medicaid fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Radiology Services,N/A,N/A,105% of the prevailing Georgia (GA) Medicaid fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Ambulatory Surgery Center Services,N/A,N/A,105% of the prevailing Georgia (GA) Medicaid Maximum Allowable Payments Outpatient Fee Schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Dialysis Services,N/A,N/A,105% of the prevailing Georgia (GA) Medicaid DME Services fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,Home Infusion Services,N/A,N/A,105% of the prevailing Georgia (GA) Medicaid fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Harbin Clinic, LLC_20170816_Dually Excuted.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Harbin Clinic, LLC. The scope of the Agreement is to include additional terms that provide compensation to the Provider for providing Covered Services to Covered Persons during evening, weekend, and holiday hours outside of their regularly scheduled core business hours.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,3.8.2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,3.8.2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Harbin Clinic_First Amendment_18-0309 CareSource Amendment - After Hours - signed (002).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Facility Participation Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the Facility Participation Agreement between CareSource Network Partners LLC and TriStar Health Systems, Inc and South Atlantic Division, Inc. The Agreement aims to include new facilities that have been acquired by the Provider. The scope of the Agreement includes adding the new facilities to Attachment C, incorporating them into Attachment A, and reimbursing them for Covered Services provided to Covered Persons at the same rates as other specified hospitals.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Georgia, Tennessee",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,03-12-2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is July 1, 2018.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HCA Facility First Amendment HCA-Tristar Health Systems Inc _ South Atlantic Division.07012018.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY DBA ESKENAZI HEALTH,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Health and Hospital Corporation of Marion County, dba Eskenazi Health. The amendment adds Indiana Medicaid Programs, Hoosier Healthwise and Healthy Indiana Plan, effective January 1, 2017. The scope of the Agreement includes the payment of claims, timing for payment of claims, and the governing law and venue for any arbitration or legal proceedings.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-6005697,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"September 2, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is September 2, 2016.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Indiana Medicaid DRG,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,Outliers and transfers reimbursed according to State Methodology,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Indiana Medicaid Fee Schedule,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,N/A,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,Physicians,Indiana Medicaid Fee Schedule,Fee Schedule,N,N/A,102%,,,,,,,102% of the current Indiana Medicaid Fee Schedule for Covered Services rendered by physicians,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,Non-physicians,Indiana Medicaid Fee Schedule,Fee Schedule,N,N/A,102%,,,,,,,102% of the current Indiana Medicaid Fee Schedule for Covered Services rendered by non-physicians,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Medicaid Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,"Reimbursement includes operating base rate, capital base rate, DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,N/A,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,N/A,,,"Home Health, Hospice, SNF, and Dialysis",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (1).PDF.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,N/A,,,Reference Lab and DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY DBA ESKENAZI HEALTH,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a first amendment to an existing agreement between CareSource and Health and Hospital Corporation of Marion County, also known as Eskenazi Health. The purpose of the amendment is to add Indiana Medicaid Programs, Hoosier Healthwise and Healthy Indiana Plan, to the Agreement. The scope of the Agreement remains the same, except for the addition of these Medicaid programs.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,5,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-6005697,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"September 2, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"September 2, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/17/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Inpatient,N/A,Indiana Medicaid DRG,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,Reimbursement according to State Methodology for outliers and transfers,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Outpatient,N/A,Indiana Medicaid Fee Schedule,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Professional Services,Physician,Indiana Medicaid Fee Schedule,Fee Schedule,Y,102% of the current Indiana Medicaid Fee Schedule for Covered Services rendered by non-physicians,102%,,,,,,,Injectable medications may be available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Professional Services,Non-Physician,Indiana Medicaid Fee Schedule,Fee Schedule,Y,102% of the current Indiana Medicaid Fee Schedule for Covered Services rendered by non-physicians,102%,,,,,,,Injectable medications may be available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Medicaid Allowed Amount,Billed Charges,Y,100% of the Medicaid Allowed Amount,100%,,,,,,,"Calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Professional Services,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,"Home Health, Hospice, SNF, and Dialysis",N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health and Hospital Corp dba Eskenazi Health Amendment Adding IN Mdcd 11.21.16 (5).PDF.txt,,,,Hospital,Reference Lab and DME,N/A,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Ancillary Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions for the provision of health care services by the provider. It includes requirements for provider qualifications, compliance with regulations, quality assessment, and performance improvement. The Agreement also covers the procedures for ending, nonrenewal, or termination of the Agreement, as well as compensation and the provider's responsibilities. Additionally, it specifies the minimum and maximum number of Medicaid members that primary care physicians must serve.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,Dec-09,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,,,,Ancillary,Home Health/Home Infusion,"Physical Therapy, Occupational Therapy, Speech Therapy, Skilled Nursing, Home Health Aide, Social Work Visit",85% of the prevailing Ohio Medicaid Fee Schedule,Fee Schedule,Y,Provider's billed charges or CareSource's fee schedule,85%,,,,,,,"Provider will bill using G-Codes; for Home Infusion Therapy Drugs, CareSource will reimburse the prevailing Medicaid fee schedule for listed codes, and for unlisted codes, CareSource will reimburse the prevailing Medicare Average Sale Price + 6% when a valid NDC code is billed.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,,,,Ancillary,Home Infusion,Various Home Infusion Services,Specific rates per code,Billed Charges,Y,Provider's billed charges or CareSource's fee schedule,,,,,,,,"For Home Infusion Therapy Drugs: For listed codes, CareSource will reimburse the prevailing Medicaid fee schedule. For unlisted codes, CareSource will reimburse the prevailing Medicare Average Sale Price + 6% when a valid NDC code is billed.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,,,,Ancillary,Medicare Services,Various Medicare Services,100% of the Medicare allowed amount,Fee Schedule,Y,Provider's billed charges or 100% of the Medicare allowed amount,100%,,,,,,,"CareSource's members have been validated to be designated as dual eligibles (i.e. qualifying for both Medicare and Medicaid) prior to enrollment in the Plan. As a result, neither the members nor CareSource shall bear any financial responsibility for deductibles, copays or coinsurance. The Provider is responsible for seeking reimbursement of these amounts from the State Medicaid program as a Secondary payer. In the event that collection efforts with the State fail, previous CMS rulings indicate that the Provider may request bad debt recovery through CMS.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Health Care Specialists -_20110916_Ancillary Services Agreement_rev 062310.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law between CareSource and Health Choice Urgent Care, LLC. It establishes the obligation for both parties to work together in good faith to resolve any disputes in a timely manner. The Agreement also includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if disputes are not resolved. It specifies that certain matters, such as intellectual property protection and indemnification claims, may be excluded from arbitration. The Agreement also addresses the termination of covered services and the governing law and venue for disputes.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20210723,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",,,,Physician/Provider/Group,,Not Specified,100% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",,,,Non-Physician,,Not Specified,90% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,,Provider's billed charges,90%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Choice Urgent Care, LLC_20210723_CareSource Agreement.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement establishes the rights and obligations between Group Practice and Plan. It outlines the conditions for assignment, use of names, compliance with regulations, and dispute resolution. The Agreement also addresses termination, including the continuation of services and transfer of medical records. It emphasizes the independent contractor relationship between the parties and the responsibility for their own acts or omissions. The Agreement is governed by applicable federal laws and the laws of the State of Ohio.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 2005-06-22.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",,,,Physician,Outpatient,N/A,Ohio Medicaid fee schedule,Fee Schedule,Y,105%,105%,,,,,,,For Medically Necessary Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",,,,Non-Physician,Outpatient,N/A,Ohio Medicaid fee schedule,Fee Schedule,Y,100%,100%,,,,,,,For Medically Necessary Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Health Specialists of Dayton,Inc_20050622_Dually Executed Contract.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Group Practice Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between Group Practice and Plan regarding reimbursement for payments made in error, termination of the Agreement, coordination of benefits, non-covered services, and correction of payments made in error.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-0917085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 20060301.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,140% of the prevailing Ohio Medicaid fee schedule for physician services,Fee Schedule,Y,140% of the prevailing Ohio Medicaid fee schedule for physician services,,,,,,,,Global fee per procedure inclusive of all facility charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,110% of the current Ohio Medicaid fee schedule for all other Covered Services,Fee Schedule,Y,110% of the current Ohio Medicaid fee schedule for all other Covered Services,,,,,,,,"Injectible medications will generally be paid according to the Ohio Medicaid fee schedule, except for those drugs that may be available through a specialty pharmacy benefits manager",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,,,,Ambulatory Surgery Center,Outpatient,Surgery,Global fee per procedure,Billed Charges,Y,Billed charges or global fee per procedure,,,,,,,,"When more than one covered procedure is performed in a single operative session, reimbursement for facility services will be 100% of the surgical group rate for the primary procedure and 50% of the surgical group rate for the secondary procedure. Any subsequent procedures will be reimbursed at zero percent of the surgical group rate.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Clinic LLC Group Practice Services Agreement_20060301.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource and Holzer Hospital Foundation. The Agreement adds Holzer Medical Center-Jackson as a party and includes attachments related to reimbursement for covered services. The Agreement's scope remains in full force and effect, except for the amendments made.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-4379491 and 31-1724085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2018",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Holzer Hospital Foundation Third Amendment_20180101.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2018.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Holzer Hospital Foundation Third Amendment_20180101.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,,,,Hospital,Inpatient,N/A,140% of the Medicare allowed amount,Billed Charges,Y,140%,140%,,,,,,,For Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,,,,Hospital,Outpatient,N/A,140% of the Medicare allowed amount,Billed Charges,Y,140%,140%,,,,,,,For Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,,,,Hospital,Laboratory,N/A,100% of the Medicare allowed amount,Billed Charges,Y,100%,100%,,,,,,,For Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,,,,Hospital,Home Health,N/A,100% of the Medicare allowed amount,Billed Charges,Y,100%,100%,,,,,,,For Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Holzer Hospital Foundation Third Amendment_20180101.txt,,,,Hospital,Hospice,N/A,100% of the Medicare allowed amount,Billed Charges,Y,100%,100%,,,,,,,For Covered Services rendered to Members,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a contractual relationship between CareSource and Hopebridge, LLC. The scope of the Agreement includes the reimbursement terms for healthcare services provided by Hopebridge, LLC to CareSource members.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,20-2605791,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2022",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,,,,MD/DO providers,Not Specified,Not Specified,Ohio Medicaid fee schedule,Fee Schedule,Y,105%,105%,,,,,,,105% of Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,,,,non-MD/non-DO providers,Not Specified,Not Specified,Ohio Medicaid fee schedule,Fee Schedule,Y,100%,100%,,,,,,,100% of Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,,,,Not Specified,Not Specified,Not Specified,Medicare Fee Schedule,Fee Schedule,Y,100%,100%,,,,,,,100% of Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_20220101_First Amendment_OH MCD Reimbursement.txt,,,,Not Specified,Not Specified,ABA Therapy,Suggested ABA rates,Fee Schedule,Y,105%,105%,,,,,,,"CareSource to pay 105% of suggested ABA rates for the codes 97153, 97155",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_OH_Base_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_OH_Base_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_OH_Base_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between Plan and Group Practice for the provision of Covered Services to Covered Persons. The Agreement outlines various provisions related to compensation, billing procedures, coordination of benefits, and the use of assistants and employees. It also includes provisions regarding the use of names, compliance with HIPAA regulations, inspections, representations, enforceability, and regulatory approval. The scope of the Agreement covers the rights, duties, and interests of both parties and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_OH_Base_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_OH_Base_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_OH_Base_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,O,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hopebridge LLC_OH_Base_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hopebridge LLC_OH_Base_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,MD/DO providers,,Not Specified,105% of Medicaid Fee Schedule,Fee Schedule,,105%,105%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hopebridge LLC_OH_Base_MP.txt,,,,non MD/non DO providers,,Not Specified,100% of Medicaid Fee Schedule,Fee Schedule,,100%,100%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,Not Specified,,Not Specified,100% of Medicare Fee Schedule,Fee Schedule,,100%,100%,,,,,,,,,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,105% of Medicaid Fee Schedule,100% of Medicaid Fee Schedule,100% of Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hopebridge LLC_OH_Base_MP.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Medicaid Reimbursement,Healthcare Exchange Reimbursement,,,,,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Date set forth on the signature page of this Agreement,CARESOURCE OHIO,"Hopebridge, LLC",,,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"105% of the prevailing Ohio Medicaid fee schedule for physician services, and 100% of the current Ohio Medicaid fee schedule for non-physician Covered Services",,,,,,,,,,,,,,,
|
||
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Hopebridge LLC_OH_Base_MP.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,100% of the Medicare allowed amount applicable to Providers,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Hopebridge LLC. The scope of the Agreement includes adding the GA Medicaid Product under tax id 20-2605791 along with the Georgia Compensation Schedule. The Agreement also states that all defined or capitalized terms shall have the same meanings as set forth in the original Agreement, and that the terms of the Agreement, except as amended, shall remain in full force and effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,20-2605791,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2/26/2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is February 11, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,2/26/2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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HopeBridgeLLC_20190211_First Amendment_ GA MCD.txt,,,,Physician/Provider/Group,Not specified,Not specified,GA Medicaid,Fee Schedule,Y,100% of the prevailing GA Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if disputes are not resolved. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the rights and interests of the Parties involved.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20180817,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Inpatient,Trach,Georgia Medicaid DRG,Fee Schedule,Y,Provider's allowable billed charges,100%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Outpatient,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,Provider's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Outpatient,Reference Laboratory,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Other Services,Home Health,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Other Services,Hospice,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Other Services,Ancillary,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Other Services,Physicians,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,For Covered Services rendered by physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,Hospital,Other Services,Physicians,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,90%,,,,,,,For Covered Services rendered by non-physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Hospital Authority of Valdosta and Lowndes County Georgia PA_20180817_ Dually Executed Agreement (1).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Amendment to the Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions for the Provider's participation in the Plan's Medicare Advantage Plan. The Agreement outlines the Provider's obligations to comply with CMS Rules, allow audits and inspections by HHS and GAO, and provide Covered Services to Covered Persons. The Agreement also addresses the Provider's obligation to adhere to the Plan's contractual obligations with CMS and the Provider's responsibility to protect Covered Persons from incurring liability for payment of fees.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Inpatient,General,Medicare Allowed Amount,Fee Schedule,Y,105%,105%,,,,,,,For Medically Necessary Covered Services rendered by Provider to D-SNP Covered Persons who receive coverage for the Medicare portion of D-SNP benefits through the Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,105%,105%,,,,,,,For Medically Necessary Covered Services rendered by Provider to D-SNP Covered Persons who receive coverage for the Medicare portion of D-SNP benefits through the Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Professional Services,General,Medicare Allowed Amount,Fee Schedule,Y,105%,105%,,,,,,,For Medically Necessary Covered Services rendered by Provider to D-SNP Covered Persons who receive coverage for the Medicare portion of D-SNP benefits through the Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,SNF,General,Medicare Allowed Amount,Fee Schedule,Y,105%,105%,,,,,,,For Medically Necessary Covered Services rendered by Provider to D-SNP Covered Persons who receive coverage for the Medicare portion of D-SNP benefits through the Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Lab,General,Medicare Allowed Amount,Fee Schedule,Y,100%,100%,,,,,,,For Medically Necessary Covered Services rendered by Provider to D-SNP Covered Persons who receive coverage for the Medicare portion of D-SNP benefits through the Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Inpatient and Outpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,140%,140%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Professional Services,General,Medicare Allowed Amount,Fee Schedule,Y,140%,140%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,"Home Health, Hospice, SNF, and Dialysis",General,Medicare Allowed Amount,Fee Schedule,Y,140%,140%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Reference Lab,General,Medicare Allowed Amount,Fee Schedule,Y,100%,100%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Authority of Valdosta and Lowndes County_20210802_Second Amendment_adding GA MP_MA DSNP.kc.txt,,,,Hospital,Physician/Group,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,"100% for physician services, 90% for non-physician services","100% for physician services, 90% for non-physician services",,,,,,,For Medically Necessary Professional Covered Services rendered to Covered Persons by Physicians employed by Provider,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between Plan and Facility for the provision of Covered Services to Covered Persons. The scope of the Agreement includes the rights, responsibilities, and obligations of Facility, as well as the utilization review/quality management processes and reimbursement agreed upon by the parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,620840204,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"June 30, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170222,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid CCR,Fee Schedule,,,107%,,,,,,,,,,,,,,,,,,,Outpatient,All Other Outpatient,N,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,Hospital,,,Fixed Fee,Fee Schedule,,,,,,,,,,Includes entire case including MRI & CT,,,,,,,,,,,,Outpatient,Emergency Room,N,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,Hospital,,,Georgia Medicaid CCR,Fee Schedule,,,107%,,,,,,,Includes entire case,,,,,,,,,,,,Outpatient,Observation,N,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,45%,,,,,,,,,,,,,,,,,,,Outpatient,Implants/Medical Devices,N,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,,,,,,,,,140,N/A,881,N/A,99284,Emergency department visit for the evaluation and management of a patient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital Corporation of America dba TriHealth Systems_20170222_Dually Executed.txt,,,,,,,,,,,,140,N/A,881,N/A,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Contract with CareSource,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to notify CareSource of a strategic price increase to Houston Hospitals, Inc.'s chargemaster. The scope of the Agreement includes the implementation of the price increase, which will affect both inpatient and outpatient charges. CareSource has the right to adjust the reimbursement calculation for outpatient services to ensure that it does not pay more than it would have paid without the chargemaster changes.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hospital_Chargemaster Increase_20200528.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hospital_Chargemaster Increase_20200528.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hospital_Chargemaster Increase_20200528.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Hospital_Chargemaster Increase_20200528.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"May 28, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,,,,Hospital,Inpatient,General,Billed Charges,Billed Charges,Y,95.60%,4.60%,,,,,,,Inpatient charges will increase by 4.6%. The adjustment factor for the inpatient outlier threshold is 95.6%.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,,,,Hospital,Outpatient,General,Billed Charges,Billed Charges,Y,96.00%,4.00%,,,,,,,Outpatient charges will increase by 4.0%. The adjustment factor for outpatient services is 96.0%.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Hospital_Chargemaster Increase_20200528.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Houston Hospitals dba.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Houston Medical Center Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a legally binding contract between two parties, CareSource and Provider. It outlines the terms and conditions for their relationship, including compliance with regulatory requirements, assignment of rights, non-exclusivity, and dispute resolution. The Agreement covers indemnification and limitation of liability, as well as the period of limitations for claims. It also includes provisions for changes in law and regulatory approval. The Agreement is comprehensive and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,2-22-17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Hospital,,,107% Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,Inpatient,Trach,Y,107%,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Hospital,,,107% Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,Outpatient,N/A,Y,107%,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Hospital,,,Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,Emergency Services,N/A,Y,Georgia Medicaid Rate without the application of a triage rate.,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,RHC,,,110% Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,110%,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Primary Care Physicians,,,109% Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,109%,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Specialty Care Physicians,,,109% Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,109%,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Ambulance,,,Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,Georgia Medicaid Rate,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Skilled Nursing Facility,,,Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,Georgia Medicaid Rate,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,Other Services,,,Georgia Medicaid Rate,Fee Schedule,,,,,,,,,,,,,,,,,,,,,,N/A,N/A,Y,Georgia Medicaid Rate,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,,,,,,,,,140,N/A,881,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Houston Hospitals dba.txt,,,,,,,,,,,,140,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Medicaid PCS - Facility Attachment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish reimbursement terms for Children's Healthcare of Atlanta at Hughes Spalding (Facility) for Medicaid Covered Services. The scope of the Agreement includes the reimbursement rates for outpatient Covered Services, the process for requesting outlier payment, the guidelines for readmission of a Medicaid Covered Person, and the provision for combining Billed Charges for services associated with the second admission on the first inpatient Claim.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,20-4144787,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"Based on the given context information, the create date of the contract cannot be determined.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,DRG,DRG payment amount,Billed Charges,Y,22.47%,100.00%,,,,,,,CareSource shall pay HSOC 100.00% of the DRG payment amount,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Short Stay/Transfer,Allowable Charges,Billed Charges,Y,22.47%,22.47%,,,,,,,Lesser of the applicable inpatient DRG payment amount or Allowable Charges for Covered Services provided at Facility multiplied by 22.47%,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Outlier,Cost of Care,Billed Charges,N,,89.30%,,,,,,,"Outlier Case reimbursement shall be equal to the Cost of Care minus the applicable DRG payment multiplied by 89.30%, plus the DRG payment",,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Emergency Services,Case Rate,Fee Schedule,Y,Maximum payment amount based upon the sum of the DRG base rate plus the GME payment amount,,,,,,,,Reimbursement according to specific case rates for different CPT codes,,,Emergency Room,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,General,Allowable Charges,Billed Charges,Y,25.45%,25.45%,,,,,,,"Total payment for outpatient services shall not exceed $10,567.80 for Covered Services provided during a single outpatient encounter or visit",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Clinical Laboratory,DCH Clinical Lab Fee Schedule,Fee Schedule,N,,,,,,,,,Reimbursement based upon the DCH Clinical Lab Fee Schedule for Outpatient Clinical Laboratory Services,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Injectables,DCH Injectable Drug Manual,Fee Schedule,N,,,,,,,,,Reimbursement at the rate specified in the DCH Injectable Drug Manual,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,Hospital,,Dental Surgery,CDT code,Fee Schedule,N,,,,,,,,,Dental surgery performed in an operating room at Facility shall be coded with an appropriate dental services CDT code,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HS Medicaid PCS - Facility Attachment_Reimbursement Terms_1.01-3.06_p10.txt,,,,,,,,,,,,N/A,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is an amendment to the Provider Agreement between CareSource Georgia, Co. and HSOC, Inc. It outlines the terms and conditions for the provision of healthcare services by HSOC and its affiliated providers to CareSource members. The amendment includes changes to the authorization process for inpatient services, reimbursement rates for outpatient emergency room services, and guidelines for reimbursement of outpatient injectables.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,12-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,Hospital,Outpatient,Emergency Room Services,Case Rate,Billed Charges,Y,"The total payment for any single outpatient emergency room services visit shall not exceed $10,567.80.",,,,,,,,Reimbursement rates for specific CPT codes are provided in the amendment.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,Hospital,Outpatient,Observation,Per Diem,Billed Charges,N,,,,,,,,,Observation stays exceeding 24 hours are reimbursed if deemed Medically Necessary by CareSource.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,Hospital,Outpatient,Injectables,DCH Injectable Drug Manual,Fee Schedule,N,,25.45%,,,,,,,Outpatient Injectable medications are reimbursed at rates specified in the DCH Injectable Drug Manual or at 25.45% of Allowable Charges if not specified.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99281,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,$70.36,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99282,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,$70.36,,,,,,,,,,,,,,
|
||
|
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99283,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,$280.64,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,$686.24,,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99285,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,"$1,093.92",,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99291,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,215.60",,,,,,,,,,,,,,
|
||
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HSOC _First Amendment_Eff. 12012017_GA MCD.txt,,,,,,,,,,,,N/A,N/A,99292,Emergency department visit for the evaluation and management of a patient,0450-0549,General,,,,,,,,,,,,,,,,,,,,,,,,,,"$2,215.60",,,,,,,,,,,,,,
|
||
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between the Plan and the Provider. It covers compliance with regulatory requirements, assignment of rights and obligations, non-exclusivity, entire agreement, enforceability and waiver, regulatory approval, notice requirements, conflict between documents, amendment process, indemnification and limitation of liability, period of limitations, dispute resolution, and governing law.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Hamilton County, Indiana",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,5-23-16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Fee Schedule,Y,150% of the Medicare Allowed Amount,150%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specially pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,,,,Professional Services,Not Specified,Not Specified,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - Fort wayne Medical Laboratory_20160523_Dually Executed Agreement_IN_J4M_MA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and Professional Clinical Laboratories LLC. The scope of the Agreement includes adding CareSource Indiana Marketplace to the original provider agreement and referencing the Indiana Plan Compensation Schedule. The Agreement remains in full force and effect, except for the specific amendments made in this Amendment.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,30-0711211,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,3/13/18,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 11/11/2016.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,,,,Laboratory,Reference Lab,Laboratory Services,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,,,,Laboratory,Reference Lab,Laboratory Services,Medicaid rate,Fee Schedule,Y,135% of the Medicaid rate,135%,,,,,,,"For codes not covered on Medicare Fee Schedules and which do not have RVU values, but which are covered on Medicaid Fee Schedules",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,,,,Laboratory,Reference Lab,Laboratory Services,Billed Charges,Billed Charges,Y,35% of billed charges,35%,,,,,,,For unlisted codes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN - PCL.txt,,,,Laboratory,Reference Lab,Laboratory Services,Medicare Fee Schedule,Fee Schedule,Y,100% according to the Medicare Fee Schedule,100%,,,,,,,For injectable medications,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource Indiana, Inc. and Indiana University Health, Inc. The scope of the Agreement includes adding IU Health Frankfort to the Agreement and updating the Hospital TIN list.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,263162145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,06-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,05-11-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,,,,,Hospital,,Billed Charges,Billed Charges,Y,60% of Medicare Contracted Allowed Compensation,60.00%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,,,,,Outpatient Surgery,,Billed Charges,Billed Charges,Y,60% of Medicare Contracted Allowed Compensation,60.00%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,,,,,DME,,Billed Charges,Billed Charges,Y,60% of Medicare Contracted Allowed Compensation,60.00%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IN Hospitals_6th Amendment MP.txt,,,,,Home Health,,Billed Charges,Billed Charges,Y,60% of Medicare Contracted Allowed Compensation,60.00%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IN Hospitals_6th Amendment MP.txt,,,,,Hospice,,Billed Charges,Billed Charges,Y,60% of Medicare Contracted Allowed Compensation,60.00%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Second Amendment to the Group Practice Agreement between CareSource Indiana, Inc. and Indiana University Health Care Associates, Inc. DBA IU Health Physicians. It outlines the terms and conditions for the provision of primary care services to covered persons under the Hoosier Healthwise and Healthy Indiana Plan Medicaid programs. The Agreement also includes provisions for payment of claims and specifies Marion County, Indiana as the venue for any arbitration or legal proceedings related to the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health Care Associates dba IU Health Physicians.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health Care Associates dba IU Health Physicians.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health Care Associates dba IU Health Physicians.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health Care Associates dba IU Health Physicians.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health Care Associates dba IU Health Physicians.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health Care Associates dba IU Health Physicians.txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health West Inc. Medicaid Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health West Inc. Medicaid Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health West Inc. Medicaid Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a third amendment to the Group Practice Agreement between CareSource Indiana, Inc. and Indiana University Health, Inc. It is effective from January 1, 2017. The purpose of the Agreement is to amend the existing Agreement to include Hoosier Healthwise and Healthy Indiana Plan Medicaid Plan Programs. The Agreement outlines the roles and responsibilities of the parties involved and includes provisions related to primary care providers, state-specific provisions for Indiana, payment of claims, and governing law and venue.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Indiana University Health West Inc. Medicaid Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Third,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Indiana University Health West Inc. Medicaid Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health West Inc. Medicaid Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health West Inc. Medicaid Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Indiana University Health West Inc. Medicaid Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,16/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Indiana University Health West Inc. Medicaid Amendment.txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a contract between CareSource Indiana, Inc. and Rehabilitation Hospital Of Indiana Inc. It outlines the terms and conditions for the provision of health services to covered persons under the CareSource Indiana, Inc. Medicaid Plan. The Agreement also includes state-specific provisions for Indiana and establishes the payment and filing deadlines for claims. The purpose of the Agreement is to govern the relationship between the parties and ensure the proper delivery and payment of covered services.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,,,,Physician/Provider/Group,,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,,,,Physician/Provider/Group,,Anesthesia,Indiana Medicaid Fee Schedule,Fee Schedule,Y,Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule,100%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,,,,Group/Ancillary,,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule.,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Bloomington HOS_Rehabilitation Hospital of Indiana Group Medicaid Amendment (3).txt,,,,Group/Ancillary,,Injectable Medications,Medicare Fee Schedule,Fee Schedule,Y,100% according to the Medicare Fee Schedule,100%,,,,,,,"Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a second amendment to the Group Practice Agreement between CareSource and Rehabilitation Hospital of Indiana Inc. It adds Hoosier Healthwise and Healthy Indiana Plan Medicaid Plan Programs to the Agreement. The Agreement also includes provisions for payment of claims and billing procedures, as well as timing for payment of claims. The State Specific Provisions for Indiana control in the event of a conflict with the Agreement. The Agreement is governed by applicable laws and the venue for any arbitration or proceeding is Marion County, Indiana.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,,,,Physician/Provider/Group,Outpatient,Anesthesia,Indiana Medicaid Fee Schedule,Fee Schedule,Y,Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,,,,Group/Ancillary,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,,,,Group/Ancillary,Outpatient,Injectable Medications,Medicare Fee Schedule,Fee Schedule,Y,100% according to the Medicare Fee Schedule,100%,,,,,,,"Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial HOS MCD_Rehabilitation Hospital of Indiana Group Medicaid Amendment (1).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement is a Second Amendment to the Group Practice Agreement between CareSource and Rehabilitation Hospital of Indiana Inc. It adds Hoosier Healthwise and Healthy Indiana Plan Medicaid Plan Programs to the Agreement. The Agreement outlines the terms and compensation schedules for these programs and specifies that the State Specific Provisions for Indiana shall control in the event of any conflict with the Agreement. The Agreement also includes provisions for the submission of claims and payment of claims by the Plan.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,7,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,10/25/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
IU Health Ball Memorial_Rehabilitation Hospital of Indiana Group Medicaid Amendment (7).txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Bloomington_MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Bloomington_MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Bloomington_MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Second Amendment to the Group Practice Agreement between CareSource Indiana, Inc. and Indiana University Health Care Associates, Inc. DBA IU Health Physicians. It is intended to amend the original Agreement and add Hoosier Healthwise and Healthy Indiana Plan Medicaid Plan Programs. The Agreement outlines the roles and responsibilities of the parties involved and includes provisions for primary care providers, state-specific provisions for Indiana, payment of claims, and governing law and venue.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MCD.txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource Indiana, Inc. and Indiana University Health, Inc. The scope of the Agreement includes adding IU Health Frankfort to the Agreement and updating the Hospital TIN list.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,06-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,05-11-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Bloomington_MP.txt,,,,Hospital,Inpatient,,Billed Charges,Billed Charges,N,,60%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Bloomington_MP.txt,,,,Hospital,Outpatient Surgery,,Billed Charges,Billed Charges,N,,60%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Bloomington_MP.txt,,,,Hospital,DME,,Billed Charges,Billed Charges,N,,60%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Bloomington_MP.txt,,,,Hospital,Home Health,,Billed Charges,Billed Charges,N,,60%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Bloomington_MP.txt,,,,Hospital,Hospice,,Billed Charges,Billed Charges,N,,60%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Second Amendment to the Group Practice Agreement between CareSource Indiana, Inc. and Indiana University Health Care Associates, Inc. DBA IU Health Physicians. It is intended to amend the original Agreement and add Hoosier Healthwise and Healthy Indiana Plan Medicaid Plan Programs. The Agreement outlines the roles and responsibilities of the parties involved and includes provisions for primary care providers, state-specific provisions for Indiana, payment of claims, and governing law and venue.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health Care Associates_2ndAmend_Add IN MCD-ID C12193473AA..txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between CareSource Indiana, Inc. and Rehabilitation Hospital of Indiana, Inc. The Agreement includes provisions for the provision of health services to covered persons under the CareSource Indiana, Inc. Medicaid Plan Programs. It also outlines the payment of claims and billing procedures, as well as the timing for payment of claims. The Agreement is specific to the state of Indiana and governs the relationship between the parties in relation to the Plan's Medicaid contract with the Indiana Family and Social Services Administration.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,100% of Hospital's allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Reference Laboratory,Laboratory,Indiana Medicaid Fee Schedule,Billed Charges,Y,,100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Home Health,Home Health,Indiana Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Hospice,Hospice,Indiana Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,Ancillary Services,Ancillary,Indiana Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,SNF,Skilled Nursing Facility,Indiana Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health INC HOS_Rehabilitation Hospital of Indiana Medicaid Amendment.txt,,,,Hospital,DME,Durable Medical Equipment,Indiana Medicaid Fee Schedule,Fee Schedule,N,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Group Practice Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a contract between CareSource Indiana, Inc. and Rehabilitation Hospital Of Indiana Inc. It outlines the terms and conditions for the provision of health services to covered persons under the CareSource Indiana, Inc. Medicaid Plan. The Agreement also includes provisions for payment of claims, filing deadlines, and timing for payment of claims. The purpose of the Agreement is to establish a contractual relationship between the parties and ensure the provision of quality healthcare services to covered persons in the state of Indiana.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,10/25/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/27/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,,,,Physician/Provider/Group,Outpatient,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of the prevailing Indiana Medicaid fee schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the prevailing Indiana Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per Indiana Medicaid Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Health West_Rehabilitation Hospital of Indiana Group Medicaid Amendment (9).txt,,,,Physician/Provider/Group,Outpatient,General,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Any Covered Service for which a Medicare Allowed Amount does not exist will be reimbursed at 130% of the prevailing Indiana Medicaid fee schedule. Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Hospital Agreement between CareSource Indiana, Inc. and Indiana University Health, Inc. The Agreement outlines the terms and conditions for the provision of healthcare services by Indiana University Health facilities. The scope of the Agreement includes the removal of certain hospitals and healthcare centers from the agreement, as well as the addition of new facilities. It also includes the restatement and replacement of Exhibit B, Table 1, Exhibit B1, Table 1, and Exhibit C of the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,263162145,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-01-2016,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,4-25-16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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IU Hospital_3rd_Amend_eff_04_01_2016_MCD.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,KAHC KPP_20190101_New Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties and establishes the governing law and venue for any arbitration or legal proceedings. It also addresses the authority of the Provider and CareSource Network Partners LLC to bind their respective affiliates to the terms of the Agreement. Additionally, it includes provisions regarding changes in law, compliance with regulatory requirements, assignment of the Agreement, non-exclusivity, and notice requirements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,36-7778,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Addendum,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is January 1, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20190101_New Provider Agreement (3).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Inpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,"142.0% of the Medicare Allowed Amount for Silver Level 3 (94%) and Silver Level 2 (87%) CareSource Marketplace Plan, 185.6% for other CareSource Marketplace Plan types",,,,,,,,"Rates increase annually by 4.5%, Dialysis services require single case agreement",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Outpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,"163.8% of the Medicare Allowed Amount for Silver Level 3 (94%) and Silver Level 2 (87%) CareSource Marketplace Plan, 229.3% for other CareSource Marketplace Plan types",,,,,,,,Rates increase annually by 4.5%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Primary Care Physician,Medicare Fee Schedule,Fee Schedule,Y,"123.8% of the Medicare Fee Schedule for Silver Level 3 (94%) and Silver Level 2 (87%) CareSource Marketplace Plan, 137.8% for other CareSource Marketplace Plan types",,,,,,,,Rates increase annually by 4.5%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Specialist,Medicare Fee Schedule,Fee Schedule,Y,"150.7% of the Medicare Fee Schedule for Neurosurgery specialist services, 134.6% for all other specialist services for Silver Level 3 (94%) and Silver Level 2 (87%) CareSource Marketplace Plan, 219.5% for Neurosurgery specialist services, 150.7% for all other specialist services for other CareSource Marketplace Plan types",,,,,,,,"Rates increase annually by 4.5%, Non-physician services at 85% of applicable rate",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Ancillary,Various,"Home Health, Hospice, Ambulatory Surgery Centers, Urgent Care, Dialysis",Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Behavioral Health,Various,Behavioral Health,Medicare Allowed Amount,Fee Schedule,Y,110% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Inpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,Pain management services do not require prior authorization,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Outpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Primary Care Physician,Medicare Fee Schedule,Fee Schedule,Y,103% of the Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Specialist,Medicare Fee Schedule,Fee Schedule,Y,103% of the Medicare Fee Schedule,,,,,,,,Non-physician services at 103% of applicable rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Ancillary,Various,"Home Health, Hospice, SNF, Urgent Care, Dialysis",Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Ancillary,Various,Reference Lab and DME,Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Ancillary,Various,Injectable Medications,Medicare Fee Schedule,Fee Schedule,Y,100% of the Medicare Fee Schedule,,,,,,,,Excludes drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Inpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,Pain management services do not require prior authorization,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Hospital,Outpatient,Acute,Medicare Allowed Amount,Fee Schedule,Y,103% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Primary Care Physician,Medicare Fee Schedule,Fee Schedule,Y,103% of the Medicare Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,Professional,Office,Specialist,Medicare Fee Schedule,Fee Schedule,Y,103% of the Medicare Fee Schedule,,,,,,,,Non-physician services at 103% of applicable rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20190101_New Provider Agreement (3).txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Kettering Adventist Health Network and Kettering Health Physician Partners LLC. The Agreement aims to modify the compensation schedule for marketplace provider reimbursement and compensation. The scope of the Agreement covers the terms and conditions related to the provision of medically necessary covered services to covered persons by the provider.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-1175717,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Hospital,Inpatient Facility Services,General,Medicare Allowed Amount,Billed Charges,Y,150% of the then current hospital specific Medicare Allowed Amount,150%,,,,,,,Inpatient facility services reimbursement rate will be 150% of the then current hospital specific Medicare Allowed Amount (excluding sequestration reduction) for those Covered Persons enrolled in the Marketplace Plan(s).,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Hospital,Outpatient Facility Services,General,Medicare Allowed Amount,Billed Charges,Y,150% of the then current hospital specific Medicare Allowed Amount,150%,,,,,,,Outpatient facility services reimbursement rate will be 150% of the then current hospital specific Medicare Allowed Amount (excluding sequestration reduction) for those Covered Persons enrolled in the CareSource Marketplace Plan(s).,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Professional,Primary (PCP) services,Primary Care,Medicare Fee Schedule,Fee Schedule,Y,148.81% of the then Current Medicare Fee Schedule,148.81%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Professional,Neurosurgery specialist services,Neurosurgery,Medicare Fee Schedule,Fee Schedule,Y,214.12% of Current Medicare Fee Schedule,214.12%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Professional,All other specialist services,Specialist,Medicare Fee Schedule,Fee Schedule,Y,164.69% of Current Medicare Fee Schedule,164.69%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Professional,Non-physician services,Non-physician,Applicable Professional Services Rate,Fee Schedule,Y,85% of the applicable Professional Services Rate,85%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Other Services,"Home health, hospice, Ambulatory Surgery Centers, urgent care and dialysis",Various,Medicare Allowed Amount,Billed Charges,Y,103% of the then current Medicare Allowed Amount,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Other Services,Reference lab and DME,Lab/DME,Medicare Allowed Amount,Billed Charges,Y,103% of the then current Medicare Allowed Amount,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Other Services,Injectable medications,Medications,Medicare Fee Schedule,Fee Schedule,Y,100% of the then current Medicare Fee Schedule,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,Other Services,Services not payable by Medicare,Various,Billed Charges,Billed Charges,Y,50% of allowable billed charges,50%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement Alliance Physicians Inc.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Kettering Adventist Health Network and Kettering Health Physician Partners LLC. The Agreement aims to modify the compensation schedule for marketplace provider reimbursement and compensation. The scope of the Agreement covers the terms and conditions related to the reimbursement rates for medically necessary covered services provided by the Provider to Covered Persons.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-1175717,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Hospital,Inpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,150% of the then current hospital specific Medicare Allowed Amount,150%,,,,,,,"Inpatient reimbursement shall be calculated as the sum of the Hospital's operating base rate and capital base rate multiplied by the Medicare DRG weight plus adjustments for indirect medical education (IME), disproportionate share (which includes DSH and Uncompensated Care addon) and outlier payments if applicable multiplied by the applicable Facility Reimbursement Rate percentage.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Hospital,Outpatient Facility Services,General,Medicare Allowed Amount,Fee Schedule,Y,150% of the then current hospital specific Medicare Allowed Amount,150%,,,,,,,Outpatient facility services reimbursement rate will be 150% of the then current hospital specific Medicare Allowed Amount.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Professional,Primary (PCP) services,Primary Care,Medicare Fee Schedule,Fee Schedule,Y,148.81% of the then Current Medicare Fee Schedule,148.81%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Professional,Neurosurgery specialist services,Neurosurgery,Medicare Fee Schedule,Fee Schedule,Y,214.12% of Current Medicare Fee Schedule,214.12%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Professional,All other specialist services,Specialist,Medicare Fee Schedule,Fee Schedule,Y,164.69% of Current Medicare Fee Schedule,164.69%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Professional,Non-physician services,Non-physician,Applicable Professional Services Rate,Fee Schedule,Y,85% of the applicable Professional Services Rate,85%,,,,,,,"Non-physician services (Physician Assistants, Nurse Practitioners and other non-physician providers)",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,"Home health, hospice, Ambulatory Surgery Centers, urgent care and dialysis",Various,Medicare Allowed Amount,Fee Schedule,Y,103% of the then current Medicare Allowed Amount,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,Reference lab and DME,Lab/DME,Medicare Allowed Amount,Fee Schedule,Y,103% of the then current Medicare Allowed Amount,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,Injectable medications,Medications,Medicare Fee Schedule,Fee Schedule,Y,100% of the then current Medicare Fee Schedule,100%,,,,,,,Except for those drugs that may be available through a specialty pharmacy benefits manager.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,Services not listed in the Medicare fee schedule,Various,Billed Charges,Billed Charges,Y,50% of billed charges,50%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,Skilled Nursing Facilities (SNF's),SNF,Medicare RUG Rate,Fee Schedule,Y,100% of the Medicare RUG Rate,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,Other Services,Services not payable by Medicare,Various,Billed Charges,Billed Charges,Y,50% of allowable billed charges,50%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KAHC KPP_20220401_Second Amendment_OH MP Reimbursement.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement of sole,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a contractual relationship between Plan and Group Practice for the provision of Health Services to Covered Persons. The scope of the Agreement includes the terms and conditions for the relationship, dispute resolution mechanisms, and the obligations and responsibilities of both parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,61-0945743,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10-20-16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 7/1/2016.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,,,,Professional Services,N/A,N/A,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,"Injectable medications will generally be paid according to the 140% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,,,,Professional Services,N/A,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the Medicare Allowed Amount,100%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kentucky Medical Services Inc_20161021_Dually Executed KY J4M_MA-ID C14216806AA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,KentuckyOne Group Practice Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the obligations and responsibilities of the Parties involved, including the provision of indemnification, limitation of liability, dispute resolution, and governing law. It also addresses the assignment of the Agreement and the non-exclusivity of the Parties. The Agreement is comprehensive and supersedes all other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1104875970,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20140806,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne Group Practice Provider Agreement_20140806_Dually Executed (1).txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,70%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FOURTH AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND Kentucky One Health, Inc.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a fourth amendment to an existing agreement between CareSource and Kentucky One Health, Inc. The purpose of the amendment is to add Indiana Medicaid Programs, Hoosier Healthwise and Healthy Indiana Plan, to the Agreement. The scope of the Agreement remains the same, except for the addition of the Indiana Medicaid Programs.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,4th,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,AM,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10/21/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is September 6, 2016.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10/26/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Trach,Indiana Medicaid DRG,Fee Schedule,Y,100% of Provider's allowable billed charges,100%,,,,,,,Outliers and transfers reimbursed according to State Methodology,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,General,Indiana Medicaid Fee Schedule,Fee Schedule,Y,100% of Provider's allowable billed charges,100%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Reference Laboratory,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Home Health,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Hospice,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Ancillary Services,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,SNF,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,DME,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Physicians,Indiana Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,Includes services rendered by non-physicians,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,General,Medicare Allowed Amount,Fee Schedule,Y,100% of billed charges,100%,,,,,,,"Includes IME, DSH, and outlier payments if applicable",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,General,Medicare Allowed Amount,Fee Schedule,Y,100% of billed charges,100%,,,,,,,,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,"Home Health, Hospice, SNF, Dialysis",Medicare Allowed Amount,Fee Schedule,Y,100% of billed charges,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KentuckyOne_20161026_4th Amendment Adding IN Mdcd_KY1 Med Grp_St Joseph_Flaget_Meade-ID C12396690AA.txt,,,,Hospital,,Reference Lab and DME,Medicare Allowed Amount,Fee Schedule,Y,100% of billed charges,100%,,,,,,,,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Kettering Physician Partners KPP Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law between the Parties. It establishes a period of limitations for initiating any arbitration or proceeding related to the Agreement. The Agreement also includes provisions for indemnification and limitation of liability. Additionally, it specifies the circumstances under which the Provider is not required to continue providing Covered Services.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Kettering Physician Partners KPP Provider Agreement_20190101 1 of 2.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Kettering Physician Partners KPP Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the terms and conditions between the Hospital and the Plan regarding the provision of services under the Value Based Reimbursement Program. It includes provisions for payment adjustments, audits, distribution of payments, termination, delegation, and confidentiality. The Agreement also addresses the format of transmissions, HIPAA compliance, security controls, disaster recovery, and data access. Additionally, it establishes performance-based incentives and outlines the reimbursement and compensation schedule for the Marketplace Provider.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,311745332,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20190101,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Hospital,Inpatient,Acute,Ohio Medicaid,Fee Schedule,Y,105% of the relevant ODM rate schedule and reimbursement methodology,105%,,,,,,,"For inpatient services, CareSource shall reimburse Provider at a rate of 105% of the relevant Ohio Department of Medicaid (\",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Hospital,Outpatient,Acute,Ohio Medicaid,Fee Schedule,Y,105% of the relevant ODM rate schedule and reimbursement methodology,105%,,,,,,,"For outpatient services, CareSource shall reimburse Provider at a rate of 105% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Professional,Primary Care Physician Services,Primary Care,Ohio Medicaid,Fee Schedule,Y,105% of the relevant ODM rate schedule and reimbursement methodology,105%,,,,,,,"For primary care physician services, CareSource shall reimburse Provider at a rate of 105% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Professional,Specialty Care Physician Services,Specialty Care,Ohio Medicaid,Fee Schedule,Y,110% of the relevant ODM rate schedule and reimbursement methodology,110%,,,,,,,"For specialty care physician services, CareSource shall reimburse Provider at a rate of 110% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Professional,Non-Physician Services,Non-Physician,Ohio Medicaid,Fee Schedule,Y,105% of the relevant ODM rate schedule and reimbursement methodology,105%,,,,,,,"For non-physician services, CareSource shall reimburse Provider at a rate of 105% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Professional,Behavioral Health Services,Behavioral Health,Ohio Medicaid,Fee Schedule,Y,110% of the relevant ODM rate schedule and reimbursement methodology,110%,,,,,,,"For behavioral health services, CareSource shall reimburse Provider at a rate of 110% of the relevant ODM rate schedule and reimbursement methodology in effect on the date of service.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Facility,Nursing Facilities,Nursing Facilities,Ohio Medicaid,Fee Schedule,N,,,,,,,,,"This agreement does not prohibit Nursing Facilities (NFs) from collecting patient liability payments from members, as specified in OAC rule 5160:1-3-24.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,Facility,Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs),FQHCs and RHCs,Ohio Medicaid,Fee Schedule,N,,,,,,,,,FQHCs and RHCs may submit claims for supplemental payments to ODM as specified in OAC rules 5160-28-07 and 5160-16-05.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Kettering Physician Partners KPP Provider Agreement_20190101 2 of 2.txt,,,,,,,,,,,,140,Depressive neuroses,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Group Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a comprehensive document that outlines the terms and conditions agreed upon by the Parties. It covers various aspects such as non-exclusivity, notice requirements, conflict resolution, and limitation of liability. The purpose of the Agreement is to establish a contractual relationship between the Parties and govern their rights and obligations. It also serves to supersede any previous agreements and ensure that all terms are clearly defined.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,61-1276316,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,8.6.14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is August 6, 2014.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,,,,Professional Services,,,130% of the Medicare Allowed Amount,Billed Charges,,,,,,,,,,General rate for most specialties,,,,,,,,,,,,Not Specified,Not Specified,Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,,,,Professional Services,,,140% of the Medicare Allowed Amount,Billed Charges,,,,,,,,,,Higher rate for specified specialties,,,,,,,,,,,,Not Specified,"Maternal Fetal Medicine, Oncology, Neurosurgery, Orthopaedics",Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,,,,Professional Services,,,110% of the Medicare Fee Schedule,Billed Charges,,,,,,,,,,Rate for injectable medications,,,,,,,,,,,,Not Specified,Not Specified,Y,Group Practice's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - (CPA) Norton Hospital Inc_20140806_Group Agreement (1).txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"""Professional Services contract""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the agreement is to establish the reimbursement rates for lab services provided by P&C Labs LLC. The agreement is a ""Professional Services contract"" and includes reimbursement rates for both Just4me and Medicare advantage. The agreement also clarifies that P&C Labs LLC is not a reference lab and operates more like a department of a hospital, providing lab services to multiple hospitals and surgery centers. The agreement does not need to be amended and the 65% reimbursement rate amendment should be rescinded.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,46-2899482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,1205835600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is April 25, 2016.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P & C Labs LLC_20170516_Admin Correspondence.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement - KY (CS),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers various aspects such as indemnification, limitation of liability, dispute resolution, and governing law. The Agreement also outlines the scope of the relationship between the Parties and includes provisions for the termination of the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,KY,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,KY,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,46-2899482,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,4-25-16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is March 1, 2016.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,,,,Professional Services,N/A,N/A,130% of the Medicare Allowed Amount,Fee Schedule,Y,Provider's billed charges,130%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,,,,Professional Services,N/A,N/A,100% of the Medicare Allowed Amount,Fee Schedule,Y,Provider's billed charges,100%,,,,,,,"Injectable medications will generally be paid according to the 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - P&C Labs LLC_20160425_Dually Executed Agreement_KY_J4M_MA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,ST Elizabeth Medical Center-Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the obligations and responsibilities of the Parties involved, including the provision of indemnification, limitation of liability, dispute resolution procedures, and governing law. It also addresses the venue for arbitration and the exclusion of certain matters from arbitration. The Agreement is binding upon the Parties and supersedes any other agreements regarding the subject matter.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,61-0445850,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1467492421,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,Hospital,,General,Billed Charges,Billed Charges,,65% of Hospital's billed charges,65%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Hospital,,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,Hospital,,General,Medicare Allowed Amount,Fee Schedule,,65% of the Medicare Allowed Amount,65%,,,,,,,For Medically Necessary Covered Services rendered to Covered Persons by Hospital,,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,Hospital,,"Hospice, Skilled Nursing Facility, and Dialysis",Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,Reimbursement Rate: 100% of the Medicare Allowed Amount,,,,,,,,,,,,Outpatient,,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,Hospital,,Reference Laboratory,Medicare Allowed Amount,Fee Schedule,,,100%,,,,,,,Reimbursement Rate: 100% of the Medicare Allowed Amount,,,,,,,,,,,,Outpatient,,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,Hospital,,Injectable medications,Medicare Fee Schedule,Fee Schedule,,,100%,,,,,,,"Reimbursement Rate: 100% of the Medicare Fee Schedule, except for those drugs that may be available through a specialty pharmacy benefits manager",,,,,,,,,,,,Outpatient,,N,,,,,,,,,,,,,,,,,,,,,,,,,
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KY - ST Elizabeth Medical Center-Hospital Agreement_20140801_Signed Hospital Agreement.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Ohio Ancillary Services Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend certain terms of the CareSource Ohio Ancillary Services Agreement between CareSource and Laboratory Corporation of America Holdings. The scope of the Agreement includes replacing certain attachments with new ones, specifying reimbursement rates for covered services, and making changes to the testing locations.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2015.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,3/25/15,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Laboratory Corporation of America Holdings_Second Amendment_20150101.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and Provider. It covers various aspects such as indemnification, limitation of liability, dispute resolution, and governing law. The scope of the Agreement includes the rights and obligations of both parties, as well as the procedures for resolving disputes and the applicable laws and venues.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,26-3717616,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20170314,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,,,,Urgent Care Center,,,90,Billed Charges,,,,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,Not Specified,Not Specified,Y,Billed Charges or Allowable,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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MedNow Urgent Care LLC_20170314_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Nationwide Children's Hospital Agreement_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Nationwide Children's Hospital Agreement_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Nationwide Children's Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Nationwide Children's Hospital Agreement_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the responsibilities and obligations of both the Plan and the Hospital. It covers various aspects such as the provision of Covered Services, employment of necessary personnel, compliance with HIPAA regulations, dispute resolution, and the release of information. The Agreement is comprehensive and supersedes any previous agreements between the parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Nationwide Children's Hospital Agreement_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-4379441,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,General,Customary Charges,Billed Charges,Y,95%,95%,,,,,,,"For Covered Services billed under Hospital's tax identification number, 31-4379441",,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,General,Customary Charges,Billed Charges,Y,92%,92%,,,,,,,"For Covered Services billed under Hospital's tax identification number, 31-4379441",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,General,Customary Charges,Billed Charges,Y,92%,92%,,,,,,,For Outpatient Clinic Services (Place of Service 11. 1500 form or Rev Code 510-519 (UB-04 form),,,Outpatient Clinic,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,Behavioral Health,Customary Charges,Billed Charges,Y,90%,90%,,,,,,,For Outpatient Behavioral Health Services (Place of Service 11- 1500 form),,,Outpatient Behavioral Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,Laboratory,Customary Charges,Billed Charges,Y,90%,90%,,,,,,,"For Outpatient Reference Lab-Only Services (Billed With a Place of Service 81 on a 1500 Claim Form or UB-04 with Revenue Codes 0300-0307, 0309, 0923, 0925)",,,Outpatient Reference Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Home Health/Home Infusion,,General,Customary Charges,Billed Charges,Y,85%,85%,,,,,,,"Services billed under Nationwide Children's Hospital Homecare's tax identification number, 31-1296332",,,Home Health/Home Infusion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospice,,General,Customary Charges,Billed Charges,Y,85%,85%,,,,,,,"Services billed under Nationwide Children's Hospital Homecare's tax identification number, 31-1296332",,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Skilled Nursing,,General,Customary Charges,Billed Charges,Y,85%,85%,,,,,,,"Services billed under Nationwide Children's Hospital Homecare's tax identification number, 31-1296332",,,Skilled Nursing,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Durable Medical Equipment,,General,Customary Charges,Billed Charges,Y,85%,85%,,,,,,,"Services billed under Nationwide Children's Hospital Homecare's tax identification number, 31-1296332",,,Durable Medical Equipment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,Hospital,,General,Customary Charges,Billed Charges,Y,85%,85%,,,,,,,"Services billed under Nationwide Children's Hospital Homecare's tax identification number, 31-1296332",,,All Other Nationwide Children's Hospital Homecare Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital Agreement_QHP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,F483F11B-2222-4B14-A9C4-DB202FCBC6C6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Amended and Restated PFK Service Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement is a Twelfth Amendment to the CareSource Amended and Restated PFK Service Agreement between CareSource and Children's Hospital and Physicians' Healthcare Network. It aims to further amend the existing Agreement and includes provisions related to the coverage of individuals enrolled in the CareSource Qualified Health Plan for the Health Insurance Exchange or Marketplace. The scope of the Agreement includes reimbursement for covered services provided by Affiliated Providers to Marketplace Covered Members.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Twelfth,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-0672132,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,06-01-2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,6/29/2022,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Hospital,Inpatient,N/A,Billed Charges,Billed Charges,Y,47%,47,,,,,,,NCH Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Hospital,Outpatient,N/A,Medicare Allowed Amount,Fee Schedule,Y,150% of the Medicare Allowed Amount,150,,,,,,,NCH Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Professional Provider,Various,N/A,Medicare Allowed Amount,Fee Schedule,Y,150% of the Medicare Allowed Amount,150,,,,,,,"Includes Pediatric Academic Association, Children's Surgical Associates Corp, Children's Anesthesia Associates, Children's Radiologic Institute, Pediatric Pathology Associates of Columbus, Ohio Pediatric Care Alliance Physicians, Children's Community Practices",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Professional Provider,Various,N/A,Medicare Allowed Amount,Fee Schedule,Y,110% of the Medicare Allowed Amount,110,,,,,,,"All other Affiliated Providers effective January 1, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Hospital,Other Services,N/A,Billed Charges,Billed Charges,Y,47%,47,,,,,,,NCH Facility Services using place of service 11 and lab services billed with a place of service 81,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Nationwide Children's Hospital_Twelfth Amendment_QHP Rate Reduction.txt,,,,Hospital,Default Rate,N/A,Billed Charges,Billed Charges,Y,47%,47,,,,,,,Services that do not have a Medicare fee schedule amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Northeast Georgia Health Partners. The scope of the Agreement includes the addition of after hours CPT codes 99050 and 99051, which will provide additional reimbursement to the Provider for medically necessary covered services provided outside of their core business hours.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,58-2131807,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"1 day of July , 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is July 1, 2012.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,,,,Unknown,Unknown,Unknown,Unknown,Unknown,Unknown,Unknown,Unknown,,,,,,,"For any Primary Care visits outside of the Providers core business hours (defined as 9:00 a.m.-5:00 p.m.), billed with CPT code, 99050 or 99051, the Provider shall receive an additional twenty-five dollars ($25.00) in reimbursement for medically necessary covered services provided to a covered person before or after the Providers core business hours.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,,,,,,,,,,,,N/A,N/A,99050,"Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Sunday), or other than in the normal sequence of time",N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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NEGA Med Cntr !st Amendment Adding afterhours 2018.05.11-MCD.txt,,,,,,,,,,,,N/A,N/A,99051,"Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service",N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Northeast Georgia Health Partners National Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties involved. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if necessary. The Agreement also specifies the governing law and venue for any disputes. Additionally, it includes provisions for indemnification and limitation of liability.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 10/31/14.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Hospital,,,105% of Provider's then-current Base Rate by the then-current State of Georgia Medicaid assigned DRG weight and adding 105% of Provider's then-current Capital Add-On Rate to the DRG calculation,Billed Charges,,,,,,,,,,Inlier Reimbursement Calculation Example provided,,,,,,,,,,,,Inpatient,All,Y,105% of Provider's Interim Outpatient Rate (IOR),,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Hospital,,,105% of Provider's then-current Interim Outpatient Rate (IOR),Billed Charges,,,,,,,,,,All other outpatient services shall be reimbursed at 105% of Provider's then-current IOR as published by DCH,,,,,,,,,,,,Outpatient,All,Y,Outpatient Services shall not exceed the maximum payable amount which shall be calculated as follows: [(105% Inpatient Base Rate + 105% Inpatient Capital Add-On) X 85.6%],,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Hospital,,,Case rates based on ER Level CPT Code without application of triage rates or diagnosis code related reductions,Billed Charges,,,,,,,,,,Rates for ER Claims without Observation or Surgery provided,,,,,,,,,,,,Emergency,All,Y,Case rates shall escalate by 3% annually,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Professional,,,105% of Provider's applicable Medicaid Allowable for the service,Billed Charges,,,,,,,,,,Urgent Care Case Rate provided,,,,,,,,,,,,All,All,Y,Covered Services with no designated Medicaid Allowable shall be reimbursed at 50% of the billed charge,,,,,,,,,,,,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Hospice,,,105% of Georgia Medicaid Per Diem Hospice Base Payment Rate,Per Diem,,,,,,,,,,Rates for Inpatient/Respite Care and General Inpatient Care provided,,,,,,,,,,,,Inpatient/Respite Care,All,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,Skilled Nursing Facility,,,105% of Georgia SNF Per Diem Level II Payment Rate,Per Diem,,,,,,,,,,Rates for Skilled Care and Sub-Acute Care provided,,,,,,,,,,,,All,All,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,775,Normal Delivery,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,Inlier Reimbursement,(105% Base Rate X DRG) + 105% Capital Add-On,,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Outlier Add-On Payment,[(Eligible Charges X ((1.05 X CCR)) - (DRG X Base Rate)] X Outlier Percent,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Short Stay / Transfer Payment,"Lesser of (1) [(105% Base Rate X DRG) + 105% Capital Add-On], -or- (2) [(Eligible Charges X ((1.05 x CCR)) + (Capital Add-On X (1.05)]",,,,,,,,,,,,
|
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,N/A,N/A,99281,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,$120.00,Level I,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$250.00,Level II,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$400.00,Level III,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$625.00,Level IV,,,,,,,,,,,,,
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"Northeast Georgia Medical Center, Inc_20170130_Dually Executed.txt",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,$850.00,Level V,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"TWENTIETH AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND NORTHSIDE HOSPITAL, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and Northside Hospital, Inc. The amendment includes additional terms and compensation to allow Northside Hospital to provide Covered Services to Covered Persons enrolled in CareSource's Medicaid Care Management Organization. The scope of the Agreement remains in full force and effect, except for the deletion and replacement of the existing Exhibit C - Georgia Plan Compensation Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"March 1, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"March 1, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospital,,General,Georgia Medicaid DRG,Billed Charges,Y,103%,103%,,,,,,,Based on Provider's current DHHR payment rate for physicians,,,Inpatient Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospital,,General,Georgia Medicaid Fee Schedule,Billed Charges,Y,103%,103%,,,,,,,,,,Outpatient Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospital,,General,Case Rate,Billed Charges,N,,$600.00,,,,,,,Revenue Code 450-459 in conjunction with CPT Codes 99281-99285,,,Emergency Room,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Laboratory,,General,Georgia Medicaid Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,Reference Laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Home Health,,General,Georgia Medicaid Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,,,,Home Health Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospice,,General,Georgia Medicaid Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospital,,Physician,Georgia Medicaid Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,For Covered Services rendered by physicians,,,Hospital Based Physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,Hospital,,Non-Physician,Georgia Medicaid Fee Schedule,Billed Charges,Y,90%,90%,,,,,,,For Covered Services rendered by non-physicians,,,Hospital Based Physicians,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,,,,,,,,,N/A,N/A,99281-99285,Emergency department visit for the evaluation and management of a patient,0450-0459,Emergency Room Case Rates,,,,,,,,,,,,,,,,,,,,,,,,,,,,,03-01-2023,$600.00,,,,,,,,,,
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Northside Hospital 20th Amendment_2023_03.01_new rates for Medicaid_NSH signed - signed (1).txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,03-01-2024,$650.00,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Caresource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is between CareSource Network Partners LLC and Northside Hospital, Inc. It allows Provider to provide Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan. The Agreement also includes terms and compensation for Provider's participation in CareSource's Qualified Health Plan Network.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,3,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,1259671,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1st, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Hospital,Inpatient,N/A,Billed Charges,Billed Charges,Y,48%,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Hospital,Outpatient,N/A,Billed Charges,Billed Charges,Y,48%,48%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Professional,N/A,Primary Care Services,Medicare fee schedule,Fee Schedule,Y,160% of the Medicare fee schedule,160%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Professional,N/A,Specialist Services,Medicare fee schedule,Fee Schedule,Y,185% of the Medicare fee schedule,185%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Professional,N/A,Super Specialist Services,Medicare fee schedule,Fee Schedule,Y,225% of the Medicare fee schedule,225%,,,,,,,Applicable to the Participating Providers identified in the below chart only,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Professional,N/A,Injectable Medications,Medicare fee schedule,Fee Schedule,Y,100% of the Medicare fee schedule,100%,,,,,,,Except those drugs that may be available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Amendment 3_Adding QHP.txt,,,,Ambulatory Surgical Center,N/A,Other Ancillary Services,Medicare fee schedule,Fee Schedule,Y,(TBD)% of the Medicare fee schedule,TBD,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers matters such as indemnification, limitation of liability, dispute resolution, and compliance with regulatory requirements. The Agreement also outlines the scope of the Provider's authority to bind its employed physicians, practitioners, and affiliates to the terms of the Agreement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2-20-17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,Hospital,Inpatient,Trach,Georgia Medicaid DRG,Fee Schedule,Y,Allowable billed charges,100%,,,,,,,Outliers and Transfer Policy reimbursed according to State Methodology,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,Hospital,Outpatient,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,Allowable billed charges,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,Hospital,Emergency Room,General,ER Case Rates,Billed Charges,N,,,,,,,,,Case rates will increase yearly by three (3%) percent on the anniversary date of the Agreement.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,Hospital,Reference Laboratory,Laboratory,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Northside Hospital_Base Contract.txt,,,,Physician/Provider/Group,General,Physicians,Georgia Medicaid Fee Schedule,Fee Schedule,Y,,100%,,,,,,,90% of the current Georgia Medicaid Fee Schedule for non-physicians. Injectable medications will be paid according to the Medicaid Fee Schedule in effect as of the date the services are rendered.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,Urgent Care Center,General,General,Global Fee,Billed Charges,N,,,,,,,,,"Global fee of $100 per visit, inclusive of all charges for facility and professional reimbursement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Northside Hospital_Base Contract.txt,,,,Ambulatory Surgery Center,General,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,Billed charges,100%,,,,,,,Compliance with CareSource's Medical Management guidelines required.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,,,,,,,,,140,N/A,881,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Northside Hospital_Base Contract.txt,,,,,,,,,,,,N/A,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CARESOURCE HOSPITAL AGREEMENT,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Hospital Agreement between CareSource and Akron General Health System. The scope of the Agreement includes the reimbursement and compensation for Medicaid hospital services, as well as the reimbursement for services provided to Covered Persons under the CareSource MarketPlace product. The Agreement also establishes the participation status of the Hospital in the Plan MarketPlace product and outlines the reimbursement rates for various types of services.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,Eleventh,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"October 1, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is October 1, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Inpatient,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,Y,107% of ODM rate schedule,107%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Outpatient,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,Y,100% of ODM rate schedule,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Professional Services,General,Ohio Department of Medicaid (ODM) rate schedule,Fee Schedule,Y,105% of ODM rate schedule,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,MarketPlace,General,Medicare Allowed Amount,Fee Schedule,Y,"151% of Medicare Allowed Amount for facility services, 130% for professional services","151% for facility services, 130% for professional services",,,,,,,Excludes sequestration,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Anesthesia Services,Anesthesiology,ASA unit rate,Billed Charges,N,,,,,,,,,Rate of $26.00 per ASA unit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,Hospital,Unpriced/Unlisted Codes,General,Billed Charges,Billed Charges,Y,"60% of billed charges for inpatient, 50% for outpatient, 45% for professional services","60% for inpatient, 50% for outpatient, 45% for professional",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Akron General Health System_Eleventh Amendment_20171001.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Cincinnati Children's Hospital Medical Center. The amendment includes the addition of Attachment A.4, which outlines the reimbursement rates for covered services provided by the hospital to members enrolled in the CareSource Just4Me Marketplace products. The scope of the Agreement is to establish the terms and conditions for reimbursement and payment for services rendered by the hospital to these members.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,95% of the Hospital's billed charges,95%,,,,,,,For Covered Services rendered to Members by Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,95% of the Hospital's billed charges,95%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF, DME",N/A,Billed Charges,Billed Charges,Y,85% of the Hospital's billed charges,85%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Reference Lab,N/A,Medicare,Fee Schedule,Y,100% of the Medicare Allowed Amount or 50% of billed charges,100% or 50%,,,,,,,Medicare allowed amount applicable to Providers as published annually in the Federal Register,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,Hospital,Injectable medications,N/A,Billed Charges,Billed Charges,Y,85% of the Hospital's billed charges,85%,,,,,,,Except for those drugs that may be available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Second Amendment_20140101_MP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Ohio Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Cincinnati Children's Hospital Medical Center. The amendment includes adding Hospital as a provider in the network established by CareSource Kentucky for the CareSource Kentucky Just4MeTM Product on the Kentucky Exchange. The scope of the Agreement remains the same, with the addition of the attachment entitled ""CareSource Kentucky Attachment A.4 Reimbursement for CareSource Kentucky Just4MeTM Addendum to Agreement.""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Ohio, Kentucky",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"1st day of January, 2017",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Billed Charges,Billed Charges,Y,95%,95%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Professional Services,N/A,Billed Charges,Billed Charges,Y,95%,95%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,"Home Health, Home Infusion, Hospice, SNF, and DME",N/A,Billed Charges,Billed Charges,Y,85%,85%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Reference Lab,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% or 50% if not assigned,100% or 50%,,,,,,,100% of the Medicare Allowed Amount or 50% of billed charges if not assigned a Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Cincinnati Children's Third Amendment_20170101_ A4 OH KY.txt,,,,Hospital,Injectable medications,N/A,Billed Charges,Billed Charges,Y,85%,85%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the existing CareSource Hospital Agreement between CareSource and Mercy Health Partners of Southwest Ohio. The Agreement outlines the terms and conditions for reimbursement of medically necessary covered services provided by the hospital to members of the CareSource Marketplace Plan. It also establishes a value-based relationship between the parties and includes provisions for termination and the inclusion of specific facilities in the plan.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,31-1091597,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,04-10-2018,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,4/14/2019,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is April 5, 2018.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Inpatient Services,N/A,145% of the Medicare allowed amount,Billed Charges,Y,145%,N/A,,,,,,,"Inpatient reimbursement shall be calculated as the sum of the Hospital's operating base rate and capital base rate multiplied by the Medicare DRG weight plus adjustments for IME, DSH, and outlier payments if applicable multiplied by the applicable Facility Reimbursement Rate percentage.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Outpatient Services,N/A,145% of the Medicare allowed amount,Billed Charges,Y,145%,N/A,,,,,,,Outpatient reimbursement based on valid codes recognized by CMS in effect on the date of service.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Professional Services,N/A,125% of the Medicare allowed amount,Billed Charges,Y,125%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,Laboratory,105% of the Medicare allowed amount,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,Durable Medical Equipment,105% of the Medicare allowed amount,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,Home Health,105% of the Medicare allowed amount,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,Hospice,105% of the Medicare allowed amount,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,ASC,105% of the Medicare allowed amount,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OH - Mercy Health Partners of Southwest Ohio Seventh Amendment_2080415.txt,,,,Hospital,Other Outpatient Services,SNF,105% of the Medicare RUG Rate,Billed Charges,Y,105%,N/A,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C10000905AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,OSU A.1-Base Contract ID C10000905AA_mcd,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is for the Plan and Hospital to collaborate on improving the Hospital's days in accounts receivable. The scope of the Agreement includes discussing and resolving discrepancies in reporting, reconciliation of aging claims, providing access to policies, and providing reports of unpaid claims.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,7/26/11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,7/26/11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Inpatient,University Hospitals,Ohio Medicaid DRG,Billed Charges,Y,115%,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Inpatient,NICU,Billed Charges,Billed Charges,N,,50%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Inpatient,Burn/Trach/Trauma,Billed Charges,Billed Charges,N,,70%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Outpatient,General,Ohio Medicaid Fee Schedule,Billed Charges,Y,108%,108%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Ambulatory Surgery,General,Ohio Medicaid ASC Fee Schedule,Billed Charges,Y,105%,105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Ambulatory Surgery,Multiple Surgical Procedures,Ohio Medicaid ASC Fee Schedule,Billed Charges,Y,50% for subsequent procedures,50%,,,,,,,The highest reimbursement grouping procedure is paid at 105%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,All Services,The James Cancer Hospital,Billed Charges,Billed Charges,N,,62%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,Hospital,Laboratory Services,University Reference Laboratories,Ohio Medicaid Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU A.1-Base Contract ID C10000905AA_mcd.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""CareSource Agreement"".",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Agreement between CareSource and The Ohio State University. The scope of the Agreement includes the addition of the CareSource Just4MeTM Qualified Health Plan to the Agreement, effective from January 1, 2014. The Agreement also specifies that any material changes to the terms of the Amendment must be made in writing with the agreement of both parties. The Sixth Amendment will remain in effect until December 31, 2015, unless renewed or otherwise adopted by the parties. All other terms and conditions of the Agreement will remain in full force and effect, unless specifically amended in the Sixth Amendment.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"December 31, 2015",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is July 1, 1996.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,Neonatal,Billed Charges,Billed Charges,Y,50%,50%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,Burn,Billed Charges,Billed Charges,Y,70%,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,Trach,Billed Charges,Billed Charges,Y,70%,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,Trauma,Billed Charges,Billed Charges,Y,70%,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,All other Inpatient Services,Medicare Allowed Amount,Billed Charges,Y,80% of the Medicare Allowed Amount,80%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Outpatient,All Outpatient Services,Medicare Allowed Amount,Billed Charges,Y,75% of the Medicare Allowed Amount,75%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Reference Lab,Reference Lab Services,Medicare Allowed Amount,Billed Charges,Y,75% of the Medicare Allowed Amount,75%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,AJCH/RSRI,Billed Charges,Billed Charges,Y,"47% for 2014, 44% for 2015","47% for 2014, 44% for 2015",,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,Hospital,Outpatient,AJCH/RSRI,Billed Charges,Billed Charges,Y,"44% for 2014, 41% for 2015","44% for 2014, 41% for 2015",,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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OSU_Sixth Amendment_QHP.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C14217265AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FIRST AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND Parkview Hospital, Inc.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to govern the provision of and payment for health services provided to covered persons under the CareSource Indiana, Inc. Medicaid Plan. The Agreement applies to providers who participate in the Plan's Medicaid Network and includes provisions related to claims submission, prior authorization, termination of the contractual relationship, compliance with laws and regulations, and other requirements. The Agreement also includes state-specific provisions for Indiana and specifies the governing law and venue for any disputes.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,35-0868085,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,January 1st 2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"December 13, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Inpatient,General,Indiana Medicaid DRG,Billed Charges,Y,103% of Provider's current DHHR payment rate,103%,,,,,,,Outliers and transfers are reimbursed according to State Methodology.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Outpatient,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Home Health,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Hospice,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Ancillary Services,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,SNF,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,DME,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Ambulance,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,103% of allowable billed charges,103%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Professional Services,General,Indiana Medicaid Fee Schedule,Billed Charges,Y,"103% of allowable billed charges for physicians, 103% for non-physicians",103%,,,,,,,Injectable medications paid according to specialty pharmacy benefits manager.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Inpatient,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicaid DRG- APR or LOC methodology with HAF adjustment factors applied,100%,,,,,,,HAF Eligible Inpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Outpatient,General,Medicaid Fee Schedule,Billed Charges,Y,100% with HAF adjustment factors applied,100%,,,,,,,HAF Eligible Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Inpatient and Outpatient,General,Medicare Fee Schedule,Billed Charges,Y,130% of the Medicaid Fee Schedule if Medicare Fee Schedule does not exist,130%,,,,,,,Non-Eligible HAF Hospital Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Professional Services,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,"Home Health, Hospice, SNF, and Dialysis",General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Reference Lab and DME,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,Hospital,Ambulance,General,Medicare Allowed Amount,Billed Charges,Y,100% of the Medicare Allowed Amount,100%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Parkview Hospital ISD 12-13-16-ID C14217265AA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers the provision of Covered Services, termination of coverage, indemnification, limitation of liability, dispute resolution, and governing law. The Agreement also outlines the scope of the Provider's obligations and the process for resolving disputes.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,27-0123687,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,27-0123687,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",,,,Professional Services,,,Medicare Allowed Amount,Billed Charges,,,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,Not Specified,Not Specified,Y,100% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",,,,Professional Services,,,Medicare Allowed Amount,Billed Charges,,,120%,,,,,,,,,,,,,,,,,,,Not Specified,Not Specified,Y,120% of the Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",,,,Urgent Care Center,,,Global Fee,Per Diem,,,Not Applicable,,,,,,,"Global fee of Seventy ($70) per Covered Person's visit, which global fee shall be inclusive of all charges for facility and professional reimbursement.",,,,,,,,,,,,Not Specified,Not Specified,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Immediate Care FP, LLC_20170124_National Agreement Template.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,SEQuVtihaefWe8_f90wpJg,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It outlines the obligations and responsibilities of both parties, including the provision of covered services and the process for dispute resolution. The Agreement also includes provisions for indemnification and limitation of liability.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,47-2449529,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,47-2449529,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20180411,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",,,,Physician/Provider/Group,,Not Specified,100% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,,Provider's billed charges,,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",,,,Non-Physician,,Not Specified,90% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,,Provider's billed charges,,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule. CareSource reserves the right to amend reimbursement policies with advanced notice.",,,,,,,,,,,,Not Specified,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Peachtree Pediatric Urgent Care, LLC _20180411_ National Agreement Template.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Pediatric Associates of Savannah_20200701_Base Contract_GA MCD,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers various aspects such as indemnification, limitation of liability, dispute resolution, and governing law. The Agreement aims to ensure compliance with regulatory requirements and outlines the rights and responsibilities of both parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is 20200701.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,,,,Physician/Provider/Group,,Physician Covered Services,115% of the prevailing Georgia (GA) Medicaid fee schedule,Fee Schedule,Y,Provider's billed charges,,,,,,,,,,,Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,,,,Physician/Provider/Group,,Non-physician Covered Services,90% of the current Georgia Medicaid fee schedule,Fee Schedule,Y,Provider's billed charges,,,,,,,,,,,Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,,,,Physician/Provider/Group,,Injectable medications,100% according to the Medicaid Fee Schedule,Fee Schedule,Y,,,,,,,,,Except for those drugs that may be available through a specialty pharmacy benefits manager,,,Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,,,,Physician/Provider/Group,,Anesthesia,Per GA Medicaid Fee Schedule,Fee Schedule,Y,,,,,,,,,Reimbursement per GA Medicaid Fee Schedule,,,Medically Necessary Covered Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Pediatric Associates of Savannah_20200701_Base Contract_GA MCD.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Caresource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and PedsNow, LLC. The scope of the Agreement includes adding Georgia Marketplace reimbursement to the agreement while keeping all other terms and provisions in effect.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,82-4646244,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"February 18, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",,,,Professional Services,N/A,N/A,140% of the Medicare Allowed Amount,Billed Charges,Y,140%,140%,,,,,,,"If there is not a Medicare Allowed Amount, then 100% of the CareSource fee schedule based on RBRVU",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",,,,Professional Services,N/A,N/A,100% of the CareSource fee schedule,Fee Schedule,Y,100% of the CareSource fee schedule,100%,,,,,,,Based on RBRVU when there is no Medicare Allowed Amount,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",,,,Injectable Medications,N/A,N/A,100% according to the Medicare Fee Schedule,Billed Charges,Y,100% according to the Medicare Fee Schedule,100%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"PedsNow, LLC _20200218_FIRST AMENDMENT_ADDING GA MARKETPLACE_JG.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law for the Parties involved. It also establishes the authority of the Provider and CareSource Network Partners LLC to bind their respective affiliates. The Agreement allows for amendments in response to changes in law or regulatory requirements. It further addresses the assignment of rights and obligations, non-exclusivity, and the entire agreement between the Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,46-2159763,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,46-2159763,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,,,,Professional Services,,,Medicare Allowed Amount,Billed Charges,,,100%,,,,,,,Reimbursement Rate: 100% of the Medicare Allowed Amount,,,,,,,,,,,,Not Specified,Not Specified,Y,100%,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,,,,Professional Services,,,Medicare Allowed Amount,Billed Charges,,,120%,,,,,,,Reimbursement Rate: 120% of the Medicare Allowed Amount,,,,,,,,,,,,Not Specified,Not Specified,Y,120%,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,,,,Urgent Care Center,,,Global Fee,Billed Charges,,,Not Applicable,,,,,,,"Global fee of Seventy ($70) per Covered Person's visit, inclusive of all charges for facility and professional reimbursement.",,,,,,,,,,,,Not Specified,Not Specified,Y,$70 per Covered Person's visit,,,,,,,,,,,,,,,,,,,,,,,,
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Perfect Health Always On Call LLC_20170130_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a network of providers, known as the CareSource Medicaid Network, to provide health care services to Medicaid beneficiaries assigned to CareSource. The Agreement allows participating providers, known as PHP Participating Providers, to accept CareSource members as patients and outlines the terms and conditions for their participation in the network. The scope of the Agreement includes the reimbursement rates, covered services, and the requirement for PHP Participating Providers to be credentialed by PHP.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,20171009,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20171009,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,,,,Hospital,,,Allowable,Billed Charges,,,,,,,,,,,,,,,,,,,,,,Inpatient,Trach,Y,For Covered Services rendered to Members below 199% of Federal Poverty Level 70%,,,,,,,,,,,,,,,,,,,,,,,,
|
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Phoebe Health Partners Inc_20171009_Executed LOA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the dispute resolution process and governing law for the Parties involved. It also establishes the authority of the Provider and CareSource Network Partners LLC to bind their respective affiliates. The Agreement allows for amendments based on changes in law and compliance with regulatory requirements. It prohibits assignment without consent, except for CareSource's right to assign to an affiliate. The Agreement is non-exclusive and supersedes all other agreements. It includes provisions for enforceability, waiver, regulatory approval, and notice.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,20-5777216,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,20-5777216,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,20-5777216,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,,,,Urgent Care Center,,,Seventy ($70) per Covered Person's visit,Billed Charges,,,N/A,,,,,,,Global fee,,,,,,,,,,,,N/A,N/A,Y,Inclusive of all charges for facility and professional reimbursement,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,,,,Professional Services,,,120% of the Medicare Allowed Amount,Fee Schedule,,,120%,,,,,,,Injectable medications will generally be paid at 100% according to the Medicare Fee Schedule,,,,,,,,,,,,N/A,N/A,Y,Provider's billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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Prime Immediate Care LLC_20180604_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Health Link_Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if necessary. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,26-2060497,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,,,,Federally Qualified Health Center,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,N/A,,,,,,,"Injectable medications will generally be paid at a specific percentage according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,Ambulatory,N/A,Yes,100% of the prevailing FQHC/RHC Encounter Rate,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,,,,Rural Health Clinic,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,N/A,,,,,,,"Injectable medications will generally be paid at a specific percentage according to the Medicare Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,Ambulatory,N/A,Yes,100% of the prevailing FQHC/RHC Encounter Rate,,,,,,,,,,,,,,,,,,,,,,,,
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Provider Health Link_Base Agreement.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between Group Practice and Plan for the provision of Covered Services to Covered Persons. It outlines the responsibilities of both parties, including the employment of assistants and employees, supply of necessary equipment, compliance with HIPAA regulations, and the use of each party's name. The Agreement also includes provisions for assignment, governing law, dispute resolution, inspections, and regulatory approval. It is the entire agreement between the parties and supersedes all other agreements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,3/13/12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 20120313.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,,,,MD/DO providers,,Not Specified,105% of Medicaid Fee Schedule,Fee Schedule,Y,Billed Charges or 105% of Medicaid Fee Schedule,105%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider or by Group Practice Providers,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,,,,non MD/non DO providers,,Not Specified,100% of Medicaid Fee Schedule,Fee Schedule,Y,Billed Charges or 100% of Medicaid Fee Schedule,100%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider or by Group Practice Providers,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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PSF PLLC_20120313_dually executed contract.txt,,,,Not Specified,,Not Specified,100% of Medicare Fee Schedule,Fee Schedule,Y,Billed Charges or 100% of Medicare Fee Schedule,100%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider or by Group Practice Providers,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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PSF PLLC_20120313_dually executed contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,DFJVV90uhlpikxBzdhknBw,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"SECOND AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND REDDY URGENT CARE, LLC",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish a contractual relationship between CareSource Network Partners LLC and Reddy Urgent Care, LLC. The scope of the Agreement includes the provision of healthcare services to Covered Persons, reimbursement policies, notification requirements, and the obligation to provide copies of visit results to primary care physicians.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,27-1271347,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"November 11, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is November 11, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",,,,Urgent Care Center,Outpatient,Urgent Care,Global Fee,Billed Charges,Y,Global fee shall be inclusive of all charges for facility and professional reimbursement,,,,,,,,Provider shall accept as payment in full a global fee of Seventy ($70) per Covered Person's visit,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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"Reddy Urgent Care, LLC_20200121_Amendment adding GA Urgent Care comp_jk.txt",,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Reid_Executed 2nd Amendment tc_MP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"SECOND AMENDMENT TO THE AGREEMENT BETWEEN CARESOURCE AND REID HOSPITAL & HEALTH CARE SERVICES, INC",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Reid_Executed 2nd Amendment tc_MP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Second Amendment to an existing agreement between CareSource and Reid Hospital & Health Care Services, Inc. It outlines the amendments made to the original agreement, including changes to specific provisions, compensation schedules, and attachments. The purpose of the Agreement is to modify and update the terms and conditions of the original agreement between the parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Indiana,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,07-01-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the current Medicare Allowed Amount,150%,,,,,,,Inpatient Facility Services Reimbursement Rate,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the current Medicare Allowed Amount,150%,,,,,,,Outpatient Facility Services Reimbursement Rate,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Laboratory,Medicare Allowed Amount,Billed Charges,Y,105% of the current Medicare Allowed Amount,105%,,,,,,,Reference Lab Reimbursement,,,Reference Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,120% of the current Medicare Allowed Amount,120%,,,,,,,Professional Services Reimbursement Rate,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Home Health,Medicare Allowed Amount,Billed Charges,Y,105% of the current Medicare Allowed Amount,105%,,,,,,,Home Health and Hospice Reimbursement Rate,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Hospice,Medicare Allowed Amount,Billed Charges,Y,105% of the current Medicare Allowed Amount,105%,,,,,,,Home Health and Hospice Reimbursement Rate,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Durable Medical Equipment,Medicare Fee Schedule,Billed Charges,Y,75% of the manufacturer's suggested retail price (MSRP),75% MSRP,,,,,,,DME Reimbursement,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Pharmacy,Average Wholesale Price (AWP),Billed Charges,Y,AWP plus 6%,AWP plus 6%,,,,,,,Injectable medications will be paid at AWP plus 6%,,,Injectable Medications,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,RHC,,General,RHC Encounter Rate,Billed Charges,Y,100% of the RHC Encounter Rate,100%,,,,,,,RHC Reimbursement,,,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicaid DRG-APR or LOC methodology,Billed Charges,Y,100% of the Medicaid DRG-APR or LOC methodology,100%,,,,,,,Inpatient Services Reimbursement,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicaid Fee Schedule,Billed Charges,Y,100% of the prevailing Medicaid Fee Schedule,100%,,,,,,,Outpatient Facility Services Reimbursement,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,General,Medicaid Fee Schedule,Billed Charges,Y,100% of the prevailing Medicaid Fee Schedule,100%,,,,,,,Professional Services Reimbursement,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Home Health,Medicaid Fee Schedule,Billed Charges,Y,100% of the prevailing Medicaid Fee Schedule,100%,,,,,,,Home Health Reimbursement,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Hospice,Medicaid Fee Schedule,Billed Charges,Y,100% of the prevailing Medicaid Fee Schedule,100%,,,,,,,Hospice Reimbursement,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Reid_Executed 2nd Amendment tc_MP.txt,,,,Hospital,,Durable Medical Equipment,Medicaid Fee Schedule,Billed Charges,Y,100% of the prevailing Medicaid Fee Schedule,100%,,,,,,,DME Reimbursement,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing agreement between CareSource and Selah House, LLC. The scope of the Agreement includes the amendment of the compensation schedules for behavioral health services provided by Selah House, LLC under the CareSource Marketplace Plan.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,11-10-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,11-10-2021,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,,,,Hospital,Inpatient,Psychiatric,Per Diem,Per Diem,N,,100%,,,,,,,Mental Health Residential less than 30 Days,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,,,,Hospital,Inpatient,Psychiatric,Per Diem,Per Diem,N,,100%,,,,,,,Mental Health Residential greater than 30 Days,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Psychiatric,Per Diem,Per Diem,N,,100%,,,,,,,Mental Health Partial Hospitalization,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Substance Use Disorder,Per Diem,Per Diem,N,,100%,,,,,,,"Substance Use Disorder Residential ASAM 3.1, 3.5, 3.7",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Substance Use Disorder,Per Diem,Per Diem,N,,100%,,,,,,,Substance Use Disorder Partial Hospitalization,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Eating Disorder,Per Diem,Per Diem,N,,194%,,,,,,,Eating Disorder Residential less than 30 Days,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Eating Disorder,Per Diem,Per Diem,N,,236%,,,,,,,Eating Disorder Residential greater than 30 Days,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Eating Disorder,Per Diem,Per Diem,N,,329%,,,,,,,Eating Disorder Partial Hospitalization,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Eating Disorder,Per Diem,Per Diem,N,,240%,,,,,,,Eating Disorder Intensive Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Outpatient,Substance Use Disorder,Per Diem,Per Diem,N,,100%,,,,,,,Methadone Treatment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,Hospital,Inpatient,Eating Disorder,Per Diem,Per Diem,N,,100%,,,,,,,Inpatient Eating Disorder,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0900,General Behavioral Health Treatments/Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0912,Partial Hospitalization less intensive (3-5 hours (half day),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0913,Partial Hospitalization intensive (6+ hours (full day),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0905,Intensive Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0906,Intensive Outpatient Chemical Dependency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Selah House_Second Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,0124,Inpatient semi-private,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,FOURTH AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND SLAVKO KUKUCKA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Slavko Kukucka. The scope of the Agreement includes increasing reimbursement rates for covered person's visits and including an attachment for urgent care compensation.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,26-1381038,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"October 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"October 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,"October 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,,,,Urgent Care Center,Outpatient,Urgent Care,Global Fee,Fee Schedule,N,,,,,,,,,Global fee includes all charges for facility and professional reimbursement. Provider must notify CareSource of changes to scheduled hours or Medical Director. Providers must have current and unrestricted licenses. Credentialing of physicians consistent with CareSource standards. Referral back to primary care physicians for follow-up unless inclusive with initial service. Provide visit results to primary care physician within 7 days. Notify primary care physician or CareSource for emergency referrals.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Slavko Kukucka _20230720_Fourth Amendment_GA MCD Rate Revision.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Provider. It covers various aspects such as indemnification, limitation of liability, dispute resolution, and governing law. The Agreement's scope includes the obligations and responsibilities of both parties, as well as the procedures for resolving disputes and the applicable laws and venues.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,27-1458479,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20190617,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,Trach,Y,Allowable,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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South Atlanta Urgent Care Clinic dba Swift Health Urgent Care Clinic _20190617_ National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""FIRST AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND SOUTHEAST GEORGIA HEALTH SYSTEM"".",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the obligations and responsibilities between the Plan and the Provider. It outlines the requirements for the quality, appropriateness, and timeliness of services provided to Medicare enrollees. The Agreement also includes provisions for audits, inspections, and the retention of records. Additionally, it addresses the accessibility and continuity of care, treatment plans for complex medical conditions, financial protections for covered persons, prompt payment, cultural considerations, and the implementation of a compliance program.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2021",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is April 16, 2020.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Professional,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,SNF,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Dialysis,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,Reference Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southeast Georgia Health System_First Amendment_Adding QHP MA DSNP.txt,,,,Ancillary,,General,Medicare Allowed Amount,Billed Charges,Y,150% of the Medicare Allowed Amount,150%,,,,,,,,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement is a contract between CareSource and Southwest General Health Center. It outlines the terms and conditions for reimbursement and compensation for covered services provided by Southwest General Health Center to CareSource members. The Agreement also includes provisions for dispute resolution and specifies that arbitration shall be conducted in accordance with the American Health Lawyers Association Alternative Dispute Resolution Services Rules of Procedure.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,Mar-14,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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Southwest General Health Center First Amended_20140301.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is March 2014.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,,,,Hospital,,General,Ohio Medicaid DRG,Fee Schedule,Y,102% of the Ohio Medicaid DRG or 100% of Hospital's allowable billed charges,102%,,,,,,,For medically necessary Covered Services rendered to Members by Hospital in accordance with the terms of this Agreement,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Hospital,,General,Ohio Medicaid fee schedule,Fee Schedule,Y,102% of the Ohio Medicaid fee schedule or 100% of Hospital's allowable billed charges,102%,,,,,,,,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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Southwest General Health Center First Amended_20140301.txt,,,,Ancillary Provider,,General,Prevailing Ohio Medicaid Fee Schedule,Fee Schedule,Y,102% of the prevailing Ohio Medicaid Fee Schedule or the Ancillary Provider's allowable billed charges,102%,,,,,,,All Home Health / Home Infusion services require prior authorization by CareSource,,,Home Health / Home Infusion,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Skilled Nursing Facility,,General,Medicare RUG,Fee Schedule,N,,87%,,,,,,,CareSource will pay 87% of the prevailing Medicare RUG based on the facility's MDS assessment and CBSA,,,Skilled Nursing Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Provider,,General,Ohio Medicaid Fee Schedule,Fee Schedule,Y,Provider's billed charges or CareSource's fee schedule for such services,102%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider in accordance with the terms of this Agreement,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Urgent Care Center,,General,Global Fee,Billed Charges,N,,,,,,,,,CareSource shall reimburse a global fee of $71.00 per visit inclusive of all charges,,,Urgent Care Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Provider,,General,Ohio Medicaid Fee Schedule,Fee Schedule,Y,Provider's billed charges or CareSource's fee schedule for such services,102%,,,,,,,For Medically Necessary Covered Services rendered to Members by Provider in accordance with the terms of this Agreement,,,Imaging And MRI,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,Provider,,General,Ohio Medicaid Fee Schedule,Fee Schedule,Y,102% of the prevailing Ohio Medicaid Fee Schedule or the Provider's allowable billed charges,102%,,,,,,,,,,All Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Southwest General Health Center First Amended_20140301.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Joseph Candler_First Amendment.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_First Amendment.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_First Amendment.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and St. Joseph's/Candler Health System, Inc. The amendment allows Provider to provide Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan and participate in CareSource's Qualified Health Plan Network. The scope of the Agreement includes the addition of specific provisions and compensation schedules for the Qualified Health Plan in Georgia.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_First Amendment.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Joseph Candler_First Amendment.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_First Amendment.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Joseph Candler_First Amendment.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"January 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"January 1, 2020",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,,,,Hospital,Inpatient and Outpatient Facility Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,195% of the current year Medicare Allowed Amount,195%,,,,,,,"Inpatient Reimbursement shall be calculated as the sum of the Provider's operating base rate and capital base rate multiplied by the Medicare DRG weight, plus adjustments for IME, DSH, and outlier payments if applicable.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,,,,Professional,Professional Services,N/A,Medicare Allowed Amount,Fee Schedule,Y,150% of the current year Medicare Allowed Amount for Locality 99,150%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,,,,Home Health/Hospice/SNF/Dialysis,"Home Health, Hospice, SNF, and Dialysis",N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the current year Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St Joseph Candler_First Amendment.txt,,,,Ancillary,Reference Lab and DME,N/A,Medicare Allowed Amount,Fee Schedule,Y,100% of the current year Medicare Allowed Amount,100%,,,,,,,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,,,,Hospital,Injectable medications,N/A,Medicare Fee Schedule,Fee Schedule,Y,195% of the current year Medicare Fee Schedule,195%,,,,,,,Except for those drugs that may be available through a specialty pharmacy benefits manager.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_First Amendment.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"The name of the Agreement is ""2ND AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND ST. JOSEPH'S/CANDLER HEALTH SYSTEM INC.""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and St. Joseph's/Candler Health System Inc. The scope of the Agreement includes adding St. Joseph's/Candler Urgent Care Centers to their existing Medicaid contract with CareSource and to CareSource Marketplace. The Agreement also includes a compensation schedule for Urgent Care Centers.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St Joseph Candler_Second Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,82-4301751,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St Joseph Candler_Second Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,01-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,1/28/2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,,,,Urgent Care Center,Urgent Care,N/A,Global Fee,Billed Charges,N,,N/A,,,,,,,"Global fee of $130.00 per Covered Person's visit, inclusive of all charges for facility and professional reimbursement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,,,,Professional/Group/Ancillary/Urgent Care,N/A,N/A,Medicare Allowed Amount,Fee Schedule,Y,140% of the Medicare Allowed Amount,140%,,,,,,,"If there is not a Medicare Allowed Amount, payment-in-full is 100% of the CareSource fee schedule based on RBRVU.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,,,,Professional/Group/Ancillary/Urgent Care,N/A,N/A,CareSource Fee Schedule,Fee Schedule,Y,100% of the CareSource fee schedule,100%,,,,,,,"For services without a Medicare Allowed Amount, payment-in-full is based on RBRVU methodology.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Joseph Candler_Second Amendment_QHP.txt,,,,Professional/Group/Ancillary/Urgent Care,N/A,N/A,Medicare Fee Schedule,Billed Charges,Y,Injectable medications paid at 100% according to the Medicare Fee Schedule,100%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicare Fee Schedule.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Group Practice Service Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the rights and obligations of the Group Practice and the Plan. It outlines the termination process, the responsibilities of each party, and the relationship between them. The Agreement also addresses the use of assistants and employees, the assignment of rights, and the compliance with HIPAA regulations. It is a comprehensive document that governs the provision of Covered Services to Covered Persons.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,6-17-2013,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 6-17-2013.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,,,,MD/DO providers,,Not Specified,105% of Medicaid Fee Schedule,Fee Schedule,Y,Billed Charges or 105% of Medicaid Fee Schedule,105%,,,,,,,,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,,,,non MD/non DO providers,,Not Specified,100% of Medicaid Fee Schedule,Fee Schedule,Y,Billed Charges or 100% of Medicaid Fee Schedule,100%,,,,,,,,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,,,,Not Specified,,Not Specified,100% of Medicare Fee Schedule,Fee Schedule,Y,Billed Charges or 100% of Medicare Fee Schedule,100%,,,,,,,,,,Not Specified,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St Vincent Medical Group Inc_Group Practice Service Agreement_20130617.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C10004753AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The name of the Agreement is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the obligations and responsibilities of the Parties involved, including the provision of indemnification, limitation of liability, dispute resolution, and governing law. It also addresses the assignment of rights and non-exclusivity. The Agreement supersedes all other agreements and contains provisions for amendments.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,61-1300608 & 61-0445850,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the given context regarding the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,Trach,Y,Billed Charges or Allowable,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,Reimbursement for services without a prevailing Medicaid allowable,,,,,,,,,,,,N/A,Physician Services,Y,35% of total eligible billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,Reimbursement for services without a prevailing Medicaid allowable,,,,,,,,,,,,N/A,Non-Physician Services,Y,35% of total eligible billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Ohio Medicaid,Fee Schedule,,,100%,,,,,,,Reimbursement for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,N/A,Injectable Medications,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Medicare,Fee Schedule,,,150%,,,,,,,Reimbursement for services without a prevailing Medicare allowable,,,,,,,,,,,,N/A,Physician Services,Y,Billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Medicare,Fee Schedule,,,150%,,,,,,,Reimbursement for services without a prevailing Medicare allowable,,,,,,,,,,,,N/A,Non-Physician Services,Y,Billed charges,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,Professional,,,Medicare,Fee Schedule,,,150%,,,,,,,Reimbursement for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,N/A,Injectable Medications,N,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"January 1, 2020",,E52C0D32-3AD7-46E6-9691-81C1305C4585,thomas Mattingly,Ohio limited liability company,"SVP, Provider Networks",2/24/2020,,,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Lori Ritchey-Baldwin,,Sr VP Finance/CFO,02-03-2020,"1 Medical Village Drive, Edgewood, Ky 41017",,,,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,100% of the prevailing Ohio Medicaid fee schedule for physician services and non-physician Covered Services,Generally paid according to the Ohio Medicaid fee schedule,Reimbursed at 35% of total eligible billed charges,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,100% of the Indiana Medicaid fee schedule in effect on the date of service,Generally paid according to the Indiana Medicaid Fee Schedule,Reimbursed at 35% of total eligible billed charges,
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,100% of the Medicare allowed amount,Generally paid at 100% of the Medicare fee schedule,,Reimbursed at 67% of Provider's total eligible billed charge
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,100% of the Medicare allowed amount,Generally paid according to 100% of the Medicare Fee schedule,,Reimbursed at 67% of Provider's total eligible billed charge
|
||
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St. Elizabeth Physicians St. Elizabeth Healthcare-Multiple MCD LOB's-ID C10004753AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,150% of the prevailing Medicare fee schedule for physician services and non-physician Covered Services,Generally paid according to 150% of the Medicare fee schedule,,Reimbursed at 67% of Provider's total eligible billed charge
|
||
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St. Mary's Health Care System_Base Contract.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Mary's Health Care System_Base Contract.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,St. Mary's Health Care System_Base Contract,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to establish the terms and conditions between the Parties involved. It covers various aspects such as contracting authority, compliance with regulatory requirements, dispute resolution, and governing law. The Agreement aims to bind the Parties and their affiliates to the agreed-upon terms and conditions.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,07-01-2017,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Base Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
St. Mary's Health Care System_Base Contract.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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St. Mary's Health Care System_Base Contract.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Mary's Health Care System_Base Contract.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,Trach,Y,Allowable,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,105%,,,,,,,,,,,,,,,,,,,Outpatient,General,Y,Allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,Covered Services provided at a hospital based reference laboratory,,,,,,,,,,,,Outpatient,Reference Laboratory,N,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Other Services,Home Health,N,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,,,,,,,,,,,,,Other Services,Hospice,N,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,100%,,,,,,,For Covered Services rendered by physicians,,,,,,,,,,,,Other Services,Physicians,N,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,Hospital,,,Georgia Medicaid Fee Schedule,Fee Schedule,,,80%,,,,,,,For Covered Services rendered by non-physicians,,,,,,,,,,,,Other Services,Physicians,N,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Mary's Health Care System_Base Contract.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,The name of the Agreement is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement outlines the process for resolving disputes between the Parties. It includes provisions for first-level and second-level dispute resolution, as well as binding arbitration if necessary. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish a framework for resolving disputes and protecting the interests of both Parties.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,12/14/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,12/14/16,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Indiana Medicaid DRG,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,Outliers and Transfer Policy reimbursed according to State Methodology,,,Inpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Indiana Medicaid Fee Schedule,Billed Charges,Y,100% of Provider's allowable billed charges,100%,,,,,,,N/A,,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Indiana Medicaid Fee Schedule,Fee Schedule,Y,N/A,100%,,,,,,,N/A,,,Reference Laboratory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,"Home Health, Hospice, Ancillary Services, Skilled Nursing Facility, DME",Indiana Medicaid Fee Schedule,Fee Schedule,Y,N/A,100%,,,,,,,N/A,,,Other Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,Physicians and Non-Physicians,Indiana Medicaid Fee Schedule,Fee Schedule,Y,N/A,100%,,,,,,,Injectable medications may be available through a specialty pharmacy benefits manager,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,"Includes operating base rate, capital base rate, DRG weight, IME, DSH, and outlier payments if applicable",,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,N/A,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,N/A,,,"Home Health, Hospice, SNF, and Dialysis",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,Hospital,,N/A,Medicare Allowed Amount,Billed Charges,Y,Provider's billed charges,100%,,,,,,,Injectable medications may be available through a specialty pharmacy benefits manager,,,Reference Lab and DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group Inc_2.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The purpose of the Agreement is to amend the existing agreement between CareSource and Outreach Professional Services Inc dba St. Vincent Medical Group. The scope of the Agreement includes the reimbursement for covered services rendered to MyCare members covered by Medicare and Ohio Medicaid through the Plan. The Agreement also covers the reimbursement for covered services rendered to MyCare members when Medicare benefits have been exhausted and Medicaid provides benefits.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"July 1, 2014",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is July 1, 2014.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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St. Vincent Medical Group_First Amendment_A.3_20140701.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Sixth Amendment to an existing agreement between CareSource and Toledo Hospital. It outlines the terms and conditions for reimbursement of Covered Services provided by the Hospital to Covered Persons. The Amendment replaces a previous rate attachment and establishes new reimbursement rates for services provided on or after the Sixth Amendment Effective Date. The Agreement also includes provisions regarding the acceptance of payment, participation in the Federal Marketplace exchange, and adherence to CMS rules and reimbursement policies.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"1st day of January, 2019",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2019.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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The Toledo Hospital_Sixth Amendment_QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,General,Medicare allowed amount,Billed Charges,Y,158% of the then current Medicare allowed amount,158%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Inpatient,Pediatrics,Medicare allowed amount,Billed Charges,Y,178% of the then current Medicare allowed amount,178%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Outpatient,General,Medicare allowed amount,Billed Charges,Y,158% of the then current Medicare allowed amount,158%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Outpatient,Pediatrics,Medicare allowed amount,Billed Charges,Y,178% of the then current Medicare allowed amount,178%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Laboratory,Medicare allowed amount,Billed Charges,Y,90% of the then current Medicare allowed amount,90%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Durable Medical Equipment,Medicare allowed amount,Billed Charges,Y,90% of the then current Medicare allowed amount,90%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Home Health,Medicare allowed amount,Billed Charges,Y,115% of the then current Medicare allowed amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,SNF,Medicare allowed amount,Billed Charges,Y,115% of the then current Medicare allowed amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Hospice,Medicare allowed amount,Billed Charges,Y,115% of the then current Medicare allowed amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Dialysis,Medicare allowed amount,Billed Charges,Y,115% of the then current Medicare allowed amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Other Outpatient Services,Injectable Medications,Medicare allowed amount,Billed Charges,Y,115% of the then current Medicare allowed amount,115%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
The Toledo Hospital_Sixth Amendment_QHP.txt,,,,Hospital,Professional Services,General,Medicare allowed amount,Billed Charges,Y,130% of the then current Medicare allowed amount,130%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
UC Health_Fourteenth Amendment_Adding KY QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
UC Health_Fourteenth Amendment_Adding KY QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Hospital Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
UC Health_Fourteenth Amendment_Adding KY QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions between CareSource and the Hospital for the provision of healthcare services to Covered Persons in the Commonwealth of Kentucky. The Agreement covers various aspects such as payment of claims, use of subcontractors, definition of emergency medical conditions, primary care providers, and the hold harmless provisions for Covered Persons. The Agreement also includes provisions for the continuation of care and the identification of products and markets.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
|
UC Health_Fourteenth Amendment_Adding KY QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
|
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"December 1, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Fourteenth Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Facility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,There is no information provided in the given context about the create date of the contract.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,101% of the Medicare Allowed Amount,101%,,,,,,,Inpatient and Outpatient Facility Services Reimbursement Rate: 101% of the Medicare Allowed Amount.,,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,101% of the Medicare Allowed Amount,101%,,,,,,,Inpatient and Outpatient Facility Services Reimbursement Rate: 101% of the Medicare Allowed Amount.,,,,,,,,,,,,Outpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,"Home Health, Hospice, SNF, and Dialysis Reimbursement Rate: 100% of the Medicare Allowed Amount.",,,,,,,,,,,,Home Health,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,"Home Health, Hospice, SNF, and Dialysis Reimbursement Rate: 100% of the Medicare Allowed Amount.",,,,,,,,,,,,Hospice,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,"Home Health, Hospice, SNF, and Dialysis Reimbursement Rate: 100% of the Medicare Allowed Amount.",,,,,,,,,,,,SNF,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,"Home Health, Hospice, SNF, and Dialysis Reimbursement Rate: 100% of the Medicare Allowed Amount.",,,,,,,,,,,,Dialysis,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,Reference Lab and DME Reimbursement Rate: 100% of the Medicare Allowed Amount.,,,,,,,,,,,,Reference Lab,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Allowed Amount,Billed Charges,,100% of the Medicare Allowed Amount,100%,,,,,,,Reference Lab and DME Reimbursement Rate: 100% of the Medicare Allowed Amount.,,,,,,,,,,,,DME,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Billed Charges,Billed Charges,,23.75% of billed charges,23.75%,,,,,,,"If there is not a Medicare Allowed Amount in effect on the date of service for any Covered Service, then Plan shall reimburse Group Practice at the following rates for any such Covered Service: University of Cincinnati Medical Center, LLC: 23.75% of billed charges",,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Billed Charges,Billed Charges,,24.84% of billed charges,24.84%,,,,,,,"If there is not a Medicare Allowed Amount in effect on the date of service for any Covered Service, then Plan shall reimburse Group Practice at the following rates for any such Covered Service: West Chester Hospital, LLC: 24.84% of billed charges",,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Billed Charges,Billed Charges,,35.57% of billed charges,35.57%,,,,,,,"If there is not a Medicare Allowed Amount in effect on the date of service for any Covered Service, then Plan shall reimburse Group Practice at the following rates for any such Covered Service: Daniel Drake Center for Post-Acute Care, LLC: 35.57% of billed charges",,,,,,,,,,,,Inpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Fee Schedule,Billed Charges,,130% of the Medicare Fee Schedule,130%,,,,,,,"For Medically Necessary Covered Services rendered to Covered Persons by Hospital, in accordance with the terms of this Agreement, Hospital shall accept as payment in full the lesser of: (i) Hospital's billed charges; or (ii) One hundred thirty percent (130%) of the Medicare Fee Schedule in effect on the date of service and specific to the services rendered, less any applicable coinsurance or copayment or deductible, that is the payment responsibility of Covered Person.",,,,,,,,,,,,Outpatient,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Fee Schedule,Billed Charges,,100% of the Medicare Fee Schedule,100%,,,,,,,"Reference Lab, DME and Injectable Medications shall be reimbursed at 100% of the Medicare Fee Schedule in effect on the date of service and specific to the services rendered, less any applicable coinsurance or copayment or deductible, that is the payment responsibility of Covered Person.",,,,,,,,,,,,Reference Lab,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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UC Health_Fourteenth Amendment_Adding KY QHP.txt,,,,Hospital,,General,Medicare Fee Schedule,Billed Charges,,100% of the Medicare Fee Schedule,100%,,,,,,,"Reference Lab, DME and Injectable Medications shall be reimbursed at 100% of the Medicare Fee Schedule in effect on the date of service and specific to the services rendered, less any applicable coinsurance or copayment or deductible, that is the payment responsibility of Covered Person.",,,,,,,,,,,,DME,,Y,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a binding contract between two parties, outlining the terms and conditions of their relationship. It covers various aspects such as non-exclusivity, arbitration procedures, governing law and venue, compliance with regulatory requirements, and assignment restrictions. The Agreement aims to establish a clear understanding between the parties and supersedes any previous agreements.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,"Franklin County, Kentucky",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Kentucky,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"March 1, 2016",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context information.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,Professional Services,Adult Primary Care Physicians,Primary Care,Medicare Allowed Amount,Billed Charges,Y,110% of the Medicare Allowed Amount,110%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,Professional Services,Adult Specialists,Specialist,Medicare Allowed Amount,Billed Charges,Y,140% of the Medicare Allowed Amount,140%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,Professional Services,Pediatric Primary Care Physicians,Primary Care,Medicare Allowed Amount,Billed Charges,Y,200% of the Medicare Allowed Amount,200%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,Professional Services,Pediatric Specialists,Specialist,Medicare Allowed Amount,Billed Charges,Y,225% of the Medicare Allowed Amount,225%,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,Professional Services,Injectable medications,Pharmacy,Medicare Fee Schedule,Billed Charges,Y,105% of the Medicare Fee Schedule,105%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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ULP Inc_ULRF_20160311_Dually Executed KY J4M_MA-C13371728AA.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,C19413627AA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement establishes the terms and conditions between the Provider and CareSource for the provision of Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan. It outlines the payment rates, filing deadlines, and appeals process for Claims. The Agreement also includes provisions for Non-Covered Services and holds the Covered Person harmless from any responsibility for such services. Compliance with applicable laws is also addressed.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,20-1842623,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,10-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is October 01, 2020.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,10-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,,,,Physician/Provider/Group,,General,103% of the prevailing Georgia (GA) Medicaid fee schedule for physician Covered Services,Fee Schedule,Y,103%,103%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager. Anesthesia will be reimbursed per GA Medicaid Fee Schedule.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,,,,Non-Physician Provider/Group,,General,85% of the current Georgia Medicaid fee schedule for non-physician Covered Services,Fee Schedule,Y,85%,85%,,,,,,,"Injectable medications will generally be paid at 100%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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University Cancer and Blood Center_20201001_Third Amendment_increase MCD rate and MP add-ID C19413627AA.txt,,,,Professional/Group/Ancillary,,General,140% of the Medicare Allowed Amount for the current year of service,Fee Schedule,Y,140%,140%,,,,,,,"If there is not a Medicare Allowed Amount dictated in the Medicare Fee Schedule for Medically Necessary Covered Services rendered to Covered Persons by Provider, then Provider shall accept as payment-in-full 100% of the CareSource fee schedule for such Covered Services, which shall be based on RBRVU reimbursement methodology.",,,Outpatient,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement outlines the dispute resolution process and governing law between CareSource and Provider. It requires the Parties to work together in good faith to resolve any disputes and provides for two levels of dispute resolution before resorting to binding arbitration. The Agreement also includes provisions for indemnification and limitation of liability. The purpose of the Agreement is to establish the terms and conditions for the provision of covered services by Provider to CareSource's covered persons.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The create date of the contract is 20161010.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,Trach,Y,Allowable,,,,,,,,,,,,,,,,,,,,,,,,
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Urgencare LLC_20191120_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,National Agreement Template,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,The Agreement outlines the process for resolving disputes between the Parties and establishes the governing law and venue for such disputes. It also includes provisions for indemnification and limitation of liability. The Agreement applies to the provision of covered services by the Provider and the obligations of CareSource as a payor.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Ohio,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,46-5736753,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,46-5736753,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,Yes,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,20161010,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,,,,Hospital,,,Billed Charges,Billed Charges,,,70%,,,,,,,For Covered Services rendered to Members below 199% of Federal Poverty Level,,,,,,,,,,,,Inpatient,Trach,Y,Allowable,,,,,,,,,,,,,,,,,,,,,,,,
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Urgent Care of Berwick LLC_20170719_National Agreement Template.txt,,,,,,,,,,,,N/A,N/A,N/A,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Dually Executed Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to establish the terms and conditions for the indemnification and limitation of liability between CareSource and WellStar. It also outlines the dispute resolution process, including binding arbitration, and specifies the governing law and venue. The Agreement covers matters such as indemnification, limitation of liability, dispute resolution, and miscellaneous terms.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,2-17-17,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The create date of the contract is February 17, 2017.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Inpatient,DRG,Georgia Medicaid DRG,Fee Schedule,Y,110% of the Georgia Medicaid DRG or allowable billed charges,,,,,,,,"Outliers reimbursed according to the methodology that DCH uses to determine reimbursement for Georgia Medicaid providers for the same types of services as of the Effective Date, including the Medicaid DRG schedule, which DCH may amend from time to time.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Outpatient,General,Georgia Medicaid Fee Schedule,Fee Schedule,Y,110% of the Georgia Medicaid Fee Schedule or allowable billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Emergency Room,ER Case Rates,Fixed Rates,Billed Charges,N,,,,,,,,,"Level 1 (99281) $70, Level 2 (99282) $150.00, Level 3 (99283) $225.00, Level 4 (99284) $425.00, Level 5 (99285) $750.00. Case Rates set forth above are not inclusive of ancillary services such as imaging, laboratory, etc.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Reference Laboratory,Laboratory,Georgia Medicaid Fee Schedule,Fee Schedule,Y,110% of the Georgia Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Home Health,Home Health,Georgia Medicaid Fee Schedule,Fee Schedule,Y,110% of the prevailing Georgia Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Hospital,Hospice,Hospice,Georgia Medicaid Fee Schedule,Fee Schedule,Y,110% of the prevailing Georgia Medicaid Fee Schedule,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Physician/Provider/Group,General,Physician Services,Georgia Medicaid Fee Schedule,Fee Schedule,Y,"110% of the prevailing Georgia Medicaid fee schedule for physician Covered Services, and 100% of the current Georgia Medicaid fee schedule for non-physician Covered Services",,,,,,,,"Injectable medications will generally be paid at 110%, according to the Medicaid Fee Schedule in effect as of the date the services are rendered, except for those drugs that may be available through a specialty pharmacy benefits manager.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,Urgent Care Center,Urgent Care,Urgent Care,Fixed Rate,Billed Charges,N,,,,,,,,,"Global fee of $150.00 per Covered Person's visit, which includes all charges for facility and professional reimbursement.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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"WellStar Medical Group, LLC_20170217_Dually Executed.txt",,,,,,,,,,,,140,N/A,99284,Emergency department visit for the evaluation and management of a patient,0450,General,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,WHS2020-00762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,"FIRST AMENDMENT TO THE CARESOURCE PROVIDER AGREEMENT BETWEEN CARESOURCE NETWORK PARTNERS LLC AND WELLSTAR HEALTH SYSTEM, INC.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The purpose of the Agreement is to amend the existing CareSource Provider Agreement between CareSource Network Partners LLC and WellStar Health System, Inc. The amendment allows Provider to provide Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan and participate in CareSource's Qualified Health Plan Network. The scope of the Agreement includes the addition of specific provisions, compensation schedules, and attachments related to the provision of Covered Services under CareSource's Qualified Health Plan.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,WHS2020-00762,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,27-3818647,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-01-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
||
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WellStar Medical Group_First Amendment_Adding QHP.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,The Create Date of the contract is not provided in the given context.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Hospital,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Inpatient and Outpatient Facility Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Professional,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Professional Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Home Health,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Home Health,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Hospice,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Hospice,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,SNF,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,SNF,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Dialysis,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Dialysis,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Laboratory,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,Reference Lab,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,DME,,Trach,196% of the Medicare Allowed Amount,Billed Charges,Y,196%,196%,,,,,,,,,,DME,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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WellStar Medical Group_First Amendment_Adding QHP.txt,,,,Physician Group,,Trach,196% of the CareSource fee schedule,Fee Schedule,Y,196%,196%,,,,,,,Based on RBRVU reimbursement methodology,,,"WellStar Medical Group, LLC",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement's purpose is to amend the CareSource Provider Agreement between CareSource Network Partners LLC and Wellstreet of Georgia, PC. The amendment modifies the term of the agreement and the compensation schedule. The scope of the agreement is to provide Medically Necessary Covered Services to Covered Persons enrolled with CareSource as a Medicaid Managed Care Organization.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,45-3191160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,"August 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,"August 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,Professional,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"August 01, 2023",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,,,,Urgent Care Center,Medicaid Urgent Care Center,Urgent Care,Global Fee,Fee Schedule,Y,$165 per visit,,,,,,,,Global fee inclusive of all charges for facility and professional reimbursement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,,,,Urgent Care Center,Medicaid Urgent Care Center,Vaccination,Per Service,Fee Schedule,Y,$17.98 for flu vaccine administration,,,,,,,,For administration of an influenza vaccine using CPT Code 90685 and 90686,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,,,,,,,,,,,,N/A,N/A,90685,Influenza vaccine,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet of Georgia PC_20230608_Fourth Amendment_GA MCD Revise UC Rates.txt,,,,,,,,,,,,N/A,N/A,90686,Influenza vaccine,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Agreement ID,What is the Agreement ID mentioned in the context? Answer in one or two words. Agreement ID:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Agreement Name,What is the name of the Agreement mentioned in the context? Name of the Agreement:,CareSource Provider Agreement,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Summary,Provide a brief description of the Agreement's purpose and scope. Return only a summary. Summary:,"The Agreement is a Second Amendment to the CareSource Provider Agreement between CareSource Network Partners LLC and WellStreet of Georgia, PC. It allows WellStreet to provide Covered Services to Covered Persons enrolled in CareSource's Qualified Health Plan and participate in CareSource's Qualified Health Plan Network. The Agreement includes additional terms and compensation for this purpose.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Agreement Sequence Number,What is the Amendment Sequence Number for tracking changes? This is found in first paragraph or title. Answer in one or two words. Amendment Sequence Number:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Contract State,In which state or states is the Contract applicable? Answer in one or two words. State name: ,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Provider State,What is the Provider's state where the rate is applicable? This is found by the compensation schedule. Answer in one or two words. Provider's state:,Georgia,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,TIN,What is the provider's Taxpayer Identification Number (TIN)? Answer in one or two words. Taxpayer Identification Number (TIN):,45-3191160,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Provider NPI,What is the National Provider Identifier (NPI) for the provider billing entity? Answer in one or two words. National Provider Identifier (NPI) is:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Group/Billing NPI,What is the National Provider Identifier for the provider group or billing entity? Answer in one or two words. National Provider Identifier:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Effective Date,What is the Effective Date mentioned in the contract? Answer in one or two words. Effective Date:,01-02-2020,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Termination Date,When does the contract terminate? Answer in one or two words. Termination Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Agreement Type,What is the agreement type? It can either be 'Base Agreement' or 'Amendment'. Answer in one or two words. Agreement Type:,Amendment,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Contract Type,What is the Contract Type? It can either be 'Professional' or 'Facility'. Answer in one or two words. Contract Type: ,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Gold Carded,Is the provider a Gold Carded Provider? Answer can either be 'yes' or 'no'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Value-Based Contract,Is this contract part of a Value Based Contract Arrangement? Answer can either be 'Yes' or 'No'.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,National Contract,Does the contract cover multiple states or markets? Indicate if it's a National Contract with Yes or No.,No,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Create Date,What is the Create Date mentioned in the contract? Create Date mentioned in the contract: ,"The Create Date of the contract is January 1, 2020.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,Modify Date,When were the last modifications made to the contract data? Answer in one or two words. Modify Date:,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,,,,Ancillary,Professional Services,N/A,145% of the Medicare Allowed Amount,Billed Charges,Y,145%,145%,,,,,,,"If there is not a Medicare Allowed Amount, then 100% of the CareSource fee schedule based on RBRVU",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Wellstreet_20200101_2nd Amendment_MP-1.txt,,,,Ancillary,Injectable medications,N/A,100% of the Medicare Fee Schedule,Billed Charges,Y,100%,100%,,,,,,,Except for drugs available through a specialty pharmacy benefits manager,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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