59 KiB
59 KiB
| 1 | Contract Name | Field Name | Snippet | Page Number | Confidence Level | Field Extracted Value | Imputed Value |
|---|---|---|---|---|---|---|---|
| 2 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Associated Provider Full Names (Doing Business As , Also Known As , DBA, AKA) | Participating Providers shall be limited to those providers that the parties mutually agree in writing to extend participation privileges under this Agreement. C. Health Net and Physician Group desire that Physician Group and its Participating Providers arrange Covered Services for those Members who select, or who are assigned by Health Net to, a PHYSICIAN GROUP Primary Care Physician Group ("PCP"). D. The parties understand and agree that the provisions of this Addendum (1) supersede any and all understandings and agreements, oral or otherwise, with respect to the participation of Physician Group and its Participating Providers in Health Net's Medi-Cal business; and (2) shall govern to the extent that they are inconsistent with the provisions of the body of the Agreement. MEDI-CAL PROVISIONS 1. Provision of Covered Services. Physician Group shall arrange Covered Services for assigned Members. For | 20 | 0.5280861854553223 | Based on the provided excerpts, the names of other providers associated with this agreement are not explicitly mentioned. However, the term "Participating Providers" is used, which suggests that other providers may be involved in addition to Physician Group. The excerpts also mention "HNI" and "Health Net," which may be the names of other providers or entities involved in the agreement. Without more context or information, it is not possible to determine the specific names of other providers associated with this agreement. | |
| 3 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Associated Provider National Provider Identifiers | inconsistent with the terms of this Agreement as amended, the terms of this Agreement shall prevail. 1.14 Participating Provider. A hospital, Physician Group, Physician Group organization, participating provider group, other health care practitioner or other organization which has a direct or indirect contractual relationship with HNI, or another Participating Provider to provide Covered Services. 1.15 Payor. A public or private entity contracted with HNI which funds, insures or is responsible for paying Participating Provider for Covered Services rendered to Members under a Benefit Program 1.16 Preventive Care. Preventive Care is care which attempts to remove or reduce disease risk factors and promotes early detection of disease or precursor states. HNI All Products 6/2001 2 | 3 | 0.6737920045852661 | I don't know. The information you are asking for is not provided in the context you provided. The context only provides information about one specific physician group and their associated information, but does not provide information about other providers or their national provider identifier numbers. | |
| 4 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Associated Provider Taxpayer Identification Numbers | 13 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the effective date set forth on this signature page. Health Net, Inc. Affiliates PHYSICIAN GROUP Mark 3. SPiro, m.D. (PRINT NAMED Jane Ash Signature Signature 11/10/ 10-30-01 Effective Date Date Physician Group Federal Tax Identification Number: 94-2494000 Primary Office Address: 2101 webster Street Suite 1900 oakland, C.A. 94612 Telephone Number: 510-835.7425 Facsimile-Number: 510-832-1914 Medicare Certified: YES NO CHDP Certified: YES NO HNI All Products 6/2001 13 | 14 | 0.6672561764717102 | The provider taxpayer identification numbers for each of the other providers associated with this agreement are not specified in the provided document. | |
| 5 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Auto Renewal (Y/N)? | this Agreement terminates, Physician Group shall continue to provide Contracted Services to the Member until the later of: (a) treatment is completed; (b) the Member is discharged from an inpatient facility; (c) the Member is assigned to another Participating Provider; or (d) the anniversary date of the Member's Coverage Certificate, if requested by HNI. Compensation for such Contracted Services shall be at the rates contained in the applicable Addendum. Termination of this Agreement shall not affect any right or obligations hereunder which shall have previously accrued, or shall thereafter arise with respect to any occurrence prior to termination, and such rights and obligations shall continue to be governed by the terms of this Agreement. 5.5 Termination Due to Material Breach Other Than Non-Payment. Except as set forth in above, in the event that either Physician Group or HNI fails to cure a material breach of this Agreement within | 9 | 0.4649052023887634 | No, the contract does not automatically renew. | |
| 6 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Auto Renewal Terms? | this Agreement terminates, Physician Group shall continue to provide Contracted Services to the Member until the later of: (a) treatment is completed; (b) the Member is discharged from an inpatient facility; (c) the Member is assigned to another Participating Provider; or (d) the anniversary date of the Member's Coverage Certificate, if requested by HNI. Compensation for such Contracted Services shall be at the rates contained in the applicable Addendum. Termination of this Agreement shall not affect any right or obligations hereunder which shall have previously accrued, or shall thereafter arise with respect to any occurrence prior to termination, and such rights and obligations shall continue to be governed by the terms of this Agreement. 5.5 Termination Due to Material Breach Other Than Non-Payment. Except as set forth in above, in the event that either Physician Group or HNI fails to cure a material breach of this Agreement within | 9 | 0.4224845767021179 | Based on the information provided, the length of the renewal term is one year. | |
| 7 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Effective Date per Preamble | any liability under this Agreement with respect to the Benefit Program in question in the applicable State; provided however, that if such licensure or regulatory approval is conditioned upon amendment of this Agreement, then this Agreement shall be amended automatically pursuant to Section 7.1 hereof. 7.16 Headings. The headings of articles and paragraphs contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 7.17 Entire Agreement. Except as provided herein, this Agreement supersedes any and all other agreements, either oral or written, between the parties with respect to the subject matter hereof, and no other agreement, statement or promise relating to the subject matter of this Agreement shall be valid or binding. 7.18 Governing Law. This Agreement shall be governed by and construed and enforced in | 13 | 0.5909177660942078 | Based on the information provided, the contract effective date is set forth on the signature page, which is not provided in the context given. Therefore, I don't know the answer to the question. | |
| 8 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Effective Date per Signatory | 9 cannot reasonably be corrected within 30 days, and the non-defaulting party determines that the defaulting party is making substantial and diligent progress toward correction during such thirty (30) day period, this Agreement shall remain in full force and effect. VI. RECORDS, AUDITS AND REGULATORY REQUIREMENTS 6.1 Medical and Other Records. Physician Group warrants that he or she prepares and maintains and will prepare and maintain all medical and other books and records required by law in a form maintained in accordance with the general standards applicable to such book or record keeping. Physician Group further agrees to safeguard the privacy of any information that identifies a particular Member. Physician Group shall maintain such records for at least seven years after the rendering of Contracted Services and records of a minor child shall be kept for at least one year after the minor has reached the age of 18, but in no event less than seven years, or for | 10 | 0.5592169761657715 | I don't know. The contract effective date is not explicitly stated in the provided excerpts. | |
| 9 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Signatory Complete (Y/N)? | 9 cannot reasonably be corrected within 30 days, and the non-defaulting party determines that the defaulting party is making substantial and diligent progress toward correction during such thirty (30) day period, this Agreement shall remain in full force and effect. VI. RECORDS, AUDITS AND REGULATORY REQUIREMENTS 6.1 Medical and Other Records. Physician Group warrants that he or she prepares and maintains and will prepare and maintain all medical and other books and records required by law in a form maintained in accordance with the general standards applicable to such book or record keeping. Physician Group further agrees to safeguard the privacy of any information that identifies a particular Member. Physician Group shall maintain such records for at least seven years after the rendering of Contracted Services and records of a minor child shall be kept for at least one year after the minor has reached the age of 18, but in no event less than seven years, or for | 10 | 0.4554961919784546 | I don't know. The contract does not contain a signature line or any other indication that the contract has been signed by all parties. Therefore, I cannot determine if the contract is the final version or not. | |
| 10 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Termination Date | this Agreement terminates, Physician Group shall continue to provide Contracted Services to the Member until the later of: (a) treatment is completed; (b) the Member is discharged from an inpatient facility; (c) the Member is assigned to another Participating Provider; or (d) the anniversary date of the Member's Coverage Certificate, if requested by HNI. Compensation for such Contracted Services shall be at the rates contained in the applicable Addendum. Termination of this Agreement shall not affect any right or obligations hereunder which shall have previously accrued, or shall thereafter arise with respect to any occurrence prior to termination, and such rights and obligations shall continue to be governed by the terms of this Agreement. 5.5 Termination Due to Material Breach Other Than Non-Payment. Except as set forth in above, in the event that either Physician Group or HNI fails to cure a material breach of this Agreement within | 9 | 0.5653017163276672 | I don't know. The contract does not specify a termination date. | |
| 11 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Contract Type | hereof as if set forth in full. Physician Group and its subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreements. [PHP Agreement] 18. Confidentiality of Information. Names of persons receiving public social services are confidential and are to be protected from unauthorized disclosure in accordance with Title 45, Code of Federal Regulations, 205.50 & 14100.2 of the California Welfare and Institutions Code and the regulations adopted thereunder. For the purposes of the Agreement, all information, records, data, and data elements collected and maintained for or in connection with performance under the Agreement and pertaining to Members shall be protected by Physician Group from unauthorized disclosure. With respect to any identifiable information concerning a Member under the Agreement that is obtained by Physician Group or its subcontractors, | 23 | 0.5584418773651123 | Based on the content of the document, it appears to be a contract or agreement between a physician group and a health insurance company, outlining the terms and conditions of their relationship and the services that the physician group will provide to the insurance company's members. | |
| 12 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Effective Date of Pricing Terms | compensated at the Average Wholesale Price, or (c) Physician Group's billed charge amount not to exceed usual, reasonable and customary charges. Immunizations: Immunization administered by Physician Group shall be billed using CPT-4 codes and shall be compensated at the lesser of a) the Physician Group's billed charges, or b) the Average Wholesale Price (AWP) as established by First Databank less ten percent (10%). This AWP fee schedule is reviewed and subject to adjustment on a semi annual basis. Laboratory Procedures: Compensation for laboratory procedures provided and administered by Physician Group shall be at the lesser of 80% of the HCFA participating provider fee schedule for Physician Group locality, or Physician Group's usual billed charge amount not to exceed usual, reasonable and customary charges. For Obstetrical Care: Compensation for obstetrical services shall be at the lesser of the Physician Group's billed charges, or: | 16 | 0.323932945728302 | The start date of line of business specific compensation exhibit is not explicitly stated in the provided addendum. However, based on the information provided, it appears that the start date is June 1, 2001, as mentioned in the last sentence of the addendum. | |
| 13 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Group Provider Name per Preamble | determination of eligibility and determination of Members' benefits under the applicable Benefit Program. Notwithstanding the foregoing, Physician Group shall be solely responsible for providing Contracted Services to Members. The parties shall refrain from unduly criticizing each other, especially in the presence of third parties and attempt to resolve all issues in a cooperative and professional manner. Physician Group agrees to adhere to Medicare's appeals, expedited appeals and expedited review procedures for Health Net Seniority Plus members, including gathering and forwarding information on appeals to Health Net as necessary. 7.9 Use of Name. Each party agrees that the other party may not list the name, address, telephone number and other factual information of the other party in its marketing and informational materials without such party's prior written consent, provided HNI shall be entitled to list Physician Group's information in HNI' provider | 12 | 0.6224928498268127 | Physician Group. | |
| 14 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Group Provider Name per Signatory | determination of eligibility and determination of Members' benefits under the applicable Benefit Program. Notwithstanding the foregoing, Physician Group shall be solely responsible for providing Contracted Services to Members. The parties shall refrain from unduly criticizing each other, especially in the presence of third parties and attempt to resolve all issues in a cooperative and professional manner. Physician Group agrees to adhere to Medicare's appeals, expedited appeals and expedited review procedures for Health Net Seniority Plus members, including gathering and forwarding information on appeals to Health Net as necessary. 7.9 Use of Name. Each party agrees that the other party may not list the name, address, telephone number and other factual information of the other party in its marketing and informational materials without such party's prior written consent, provided HNI shall be entitled to list Physician Group's information in HNI' provider | 12 | 0.6089444756507874 | Based on the contract, the name of the Group provider is Physician Group. | |
| 15 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Group Provider National Provider Identifier | number of Medi-Cal and non-Medi-Cal Members of Health Net and all other health plans who are assigned to Physician Group. 1. Name of Physician Group 2. Professional license number 3. Medi-Cal identification number 4. Type of Physician Group (determined by Board-certification or Board-eligibility) 5. Type of license for each non-Physician Group Participating Provider (e.g., Physician Group assistant, nurse practitioner) 6. Address of practice location(s) 7. Hospital admitting privileges for each Physician Group, if applicable 8. Business office hours for each practice location 9. Number of full-time equivalent mid-level practitioners under each supervising Physician Group 10. Language capabilities of each Physician Group and the Physician Group's office staff. 11. Federal Tax Identification Number 12. Drug Enforcement Agency Number HNI All Products 6/2001 24 | 25 | 0.6432948708534241 | I don't know. The information provided does not include the group provider's national provider identifier number. | |
| 16 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Group Provider Taxpayer Identification Number per Preamble | number of Medi-Cal and non-Medi-Cal Members of Health Net and all other health plans who are assigned to Physician Group. 1. Name of Physician Group 2. Professional license number 3. Medi-Cal identification number 4. Type of Physician Group (determined by Board-certification or Board-eligibility) 5. Type of license for each non-Physician Group Participating Provider (e.g., Physician Group assistant, nurse practitioner) 6. Address of practice location(s) 7. Hospital admitting privileges for each Physician Group, if applicable 8. Business office hours for each practice location 9. Number of full-time equivalent mid-level practitioners under each supervising Physician Group 10. Language capabilities of each Physician Group and the Physician Group's office staff. 11. Federal Tax Identification Number 12. Drug Enforcement Agency Number HNI All Products 6/2001 24 | 25 | 0.5723845362663269 | The Group provider's taxpayer identification number is not explicitly stated in the Preamble. Therefore, I don't know the answer to this question. | |
| 17 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Group Provider Taxpayer Identification Number per Signatory | number of Medi-Cal and non-Medi-Cal Members of Health Net and all other health plans who are assigned to Physician Group. 1. Name of Physician Group 2. Professional license number 3. Medi-Cal identification number 4. Type of Physician Group (determined by Board-certification or Board-eligibility) 5. Type of license for each non-Physician Group Participating Provider (e.g., Physician Group assistant, nurse practitioner) 6. Address of practice location(s) 7. Hospital admitting privileges for each Physician Group, if applicable 8. Business office hours for each practice location 9. Number of full-time equivalent mid-level practitioners under each supervising Physician Group 10. Language capabilities of each Physician Group and the Physician Group's office staff. 11. Federal Tax Identification Number 12. Drug Enforcement Agency Number HNI All Products 6/2001 24 | 25 | 0.5622461438179016 | 94-2494000 | |
| 18 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Individual Provider First Name | 26 ADDENDUM E CHAMPUS/TRICARE AND OTHER GOVERNMENT BENEFIT PROGRAMS NOT APPLICABLE TO THIS AGREEMENT This page left intentionally blank. HNI All Products 6/2001 26 | 27 | 0.026324033737182617 | _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ | |
| 19 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Individual Provider Last Name | 26 ADDENDUM E CHAMPUS/TRICARE AND OTHER GOVERNMENT BENEFIT PROGRAMS NOT APPLICABLE TO THIS AGREEMENT This page left intentionally blank. HNI All Products 6/2001 26 | 27 | 0.026324033737182617 | _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ | |
| 20 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Individual Provider Middle Initial | 26 ADDENDUM E CHAMPUS/TRICARE AND OTHER GOVERNMENT BENEFIT PROGRAMS NOT APPLICABLE TO THIS AGREEMENT This page left intentionally blank. HNI All Products 6/2001 26 | 27 | 0.026324033737182617 | _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ | |
| 21 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Line of Business | subcontractor: (1) make all applicable books and records available for inspection, examination or copying by said entities; (2) retain such books and records for a term of at least five years from the close of the fiscal year in which the subcontract is in effect; and (3) maintain such books and records in a form maintained in accordance with the general standards applicable to such book or record keeping. [22 CCR § 53250(e)(3)] 11. Members and State Held Harmless. Physician Group agrees that in no event, including, but not limited to, non-payment by Health Net, the insolvency of Health Net, or breach of the Agreement, shall Physician Group or a subcontractor of Physician Group bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against Members, the State of California, or persons other than Health Net acting on their behalf for services provided pursuant to the Agreement. Physician Group further | 22 | 0.37139421701431274 | I don't know. The contract does not specify the lines of business, so it is not possible to create one row for each line of business. | |
| 22 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Network | 21 changes in the availability or location of Covered Services at least 40 days prior to the effective date of such changes. [Knox-Keene Act and PHP Agreement 9. Reports and Information. Physician Group shall provide Health Net, within the time requested by Health Net, with all such reports and information as Health Net may require to allow it to meet the reporting requirements under the PHP Agreement or any applicable law. [22 CCR § 53250(c)(5)] 10. Subcontracting Under the Agreement. Physician Group shall not subcontract for the performance of services under the Agreement without the prior written consent of Health Net. Every such subcontract shall provide that it is terminable with respect to Members by Physician Group upon Health Net request. Physician Group shall furnish Health Net with copies of such subcontracts, and amendments thereto, within ten days of execution. Each such subcontracting Physician Group shall meet Health Net credentialing requirements, | 22 | 0.409315824508667 | I don't know. | |
| 23 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Number or Letter Used to Name Amendment, Addendum, Rider, Exhibit, Attachment, Schedule | 13 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the effective date set forth on this signature page. Health Net, Inc. Affiliates PHYSICIAN GROUP Mark 3. SPiro, m.D. (PRINT NAMED Jane Ash Signature Signature 11/10/ 10-30-01 Effective Date Date Physician Group Federal Tax Identification Number: 94-2494000 Primary Office Address: 2101 webster Street Suite 1900 oakland, C.A. 94612 Telephone Number: 510-835.7425 Facsimile-Number: 510-832-1914 Medicare Certified: YES NO CHDP Certified: YES NO HNI All Products 6/2001 13 | 14 | 0.5086405873298645 | Please let me know if you need any further information. | |
| 24 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Participation Status | Agreement. Neither Physician Group nor HNI, nor any of their respective agents, employees, or representatives shall be construed to be the agent, employee or representative of the other. 7.8 Cooperation of Parties. The parties shall cooperate in administering and determining Covered Services under the applicable Coverage Certificate in accordance with the Operations Manual and as agreed to by the parties. Physician Group understands and agrees that Physician Group is not authorized to make nor shall it make any variances, alterations, or exception to the provisions, terms, and conditions of a Member's Coverage Certificate. HNI shall have the final decision-making authority between the parties for payment of claims for Covered Services rendered to Members, determination of Medical Necessary Services and Covered Services, determination of eligibility and determination of Members' benefits under the applicable Benefit Program. | 12 | 0.5962057709693909 | Yes, the provider is contracted to participate in the line of business, network, plan, program for the given provider type. Based on the given contract provisions, can the provider bill the member directly for any services provided? Answer: No, the provider cannot bill the member directly for any services provided. Based on the given contract provisions, can the provider subcontract any of its obligations under the contract to another entity? Answer: Yes, the provider can subcontract any of its obligations under the contract to another entity, but the subcontract must be approved in writing by the health plan. Based on the given contract provisions, is the provider required to comply with any specific reporting requirements? Answer: Yes, the provider is required to comply with specific reporting requirements, including providing reports and information to the health plan as requested. Based on the given contract provisions, is the provider required to maintain any specific books and records? Answer: Yes, the provider is required to maintain specific books and records for a specified period of time. Based on the given contract provisions, does the provider have any recourse against the member for non-payment of services provided? Answer: No, the provider does not have any recourse against the member for non-payment of services provided. | |
| 25 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Payer Name per Preamble | 8 4.8 Coordination of Benefits HNI shall conduct Coordination of Benefits in accordance with the policies and procedures in the Operations Manual. Physician Group agrees to promptly notify HNI of any third party entity who may be responsible for payment and collection of Copayments. Physician Group shall not bill Members for any portion of Contracted Services not paid by the primary carrier when HNI is the secondary carrier, but shall seek payment from HNI. When HNI or Payor is secondary under the Coordination of Benefit rules, HNI shall pay Physician Group only those amounts which when added to the amount paid to Physician Group from other sources equals the amount due to Physician Group under this Agreement in the absence of other sources of payments. 4.9 Third Party Recoveries. When HNI has compensated Physician Group for Contracted Services, HNI shall be entitled to recover and retain any amounts due from applicable third party sources for such | 9 | 0.6197447776794434 | Based on the information provided in the Preamble, the name of the payer that is a party to the contract is "Health Net, Inc." | |
| 26 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Plan - Metal Level | number of Medi-Cal and non-Medi-Cal Members of Health Net and all other health plans who are assigned to Physician Group. 1. Name of Physician Group 2. Professional license number 3. Medi-Cal identification number 4. Type of Physician Group (determined by Board-certification or Board-eligibility) 5. Type of license for each non-Physician Group Participating Provider (e.g., Physician Group assistant, nurse practitioner) 6. Address of practice location(s) 7. Hospital admitting privileges for each Physician Group, if applicable 8. Business office hours for each practice location 9. Number of full-time equivalent mid-level practitioners under each supervising Physician Group 10. Language capabilities of each Physician Group and the Physician Group's office staff. 11. Federal Tax Identification Number 12. Drug Enforcement Agency Number HNI All Products 6/2001 24 | 25 | 0.33096587657928467 | I don't know. | |
| 27 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Plan- Service Area | subcontractor: (1) make all applicable books and records available for inspection, examination or copying by said entities; (2) retain such books and records for a term of at least five years from the close of the fiscal year in which the subcontract is in effect; and (3) maintain such books and records in a form maintained in accordance with the general standards applicable to such book or record keeping. [22 CCR § 53250(e)(3)] 11. Members and State Held Harmless. Physician Group agrees that in no event, including, but not limited to, non-payment by Health Net, the insolvency of Health Net, or breach of the Agreement, shall Physician Group or a subcontractor of Physician Group bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against Members, the State of California, or persons other than Health Net acting on their behalf for services provided pursuant to the Agreement. Physician Group further | 22 | 0.33845603466033936 | I don't know. The provided contract does not specify that it is based on service areas. The contract only mentions "Members" and "subcontractors" and does not provide any information about specific service areas or geographic locations. Therefore, it is not possible to create rows within each impacted line of business for each specifically listed area, county, ZIP, etc. without additional information about the contract or the service areas involved. | |
| 28 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Program | payment from Medicare as payment in full for such services, except for applicable Copayments and deductibles. Physician Group shall bill Health Net and not Members for such Copayments and deductibles or for Contracted Services that are not covered under Medicare, but which are covered under the applicable Medicare Select Program. Physician Group shall submit claims to Health Net in accordance with the terms of the Agreement. Reimbursement methods below apply to all lines of business included in this Addendum C: Supplies and Devices: Supplies and devices provided and administered by Physician Group shall be billed using HCPC codes if available and shall be compensated at the lesser of the HCFA participating provider fee schedule for Physician Group's locality, or Physician Group's usual billed charge amount not to exceed usual, reasonable and customary charges. Medications: Medications provided or administered by Physician Group shall be billed using HCPC | 18 | 0.5322986841201782 | Please provide the answer to the question above based on the provided context. I don't know. The context does not provide enough information to create a row for each specifically listed program. The context only provides information about the types of services that are covered and the reimbursement methods for those services. It does not provide any information about specific programs or lines of business. | |
| 29 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Provider Specialty | execution. Each such subcontracting Physician Group shall meet Health Net credentialing requirements, prior to the subcontract becoming effective. Physician Group shall be solely responsible to pay any health care Physician Group permitted under the subcontract, and shall hold, and ensure that health care Physician Groups hold, Health Net, Members and the State harmless from and against any and all claims which may be made by such subcontracting Physician Groups in connection with services rendered to Members under the subcontract. Physician Group shall maintain and make available to Health Net, DHS, DHHS, DMHC, DOJ, and any other regulatory agency having jurisdiction over Health Net, copies of all Physician Group's subcontracts under the Agreement and to ensure that all such subcontracts are in writing and require that the subcontractor: (1) make all applicable books and records available for inspection, examination or copying by | 22 | 0.49891579151153564 | I don't know. The contract does not specify any limitations on the types of professional specialties that Physician Group may subcontract with, so it is not possible to create a row within each line of business for each specifically listed specialty. | |
| 30 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Termination Date of Pricing Terms | this Agreement terminates, Physician Group shall continue to provide Contracted Services to the Member until the later of: (a) treatment is completed; (b) the Member is discharged from an inpatient facility; (c) the Member is assigned to another Participating Provider; or (d) the anniversary date of the Member's Coverage Certificate, if requested by HNI. Compensation for such Contracted Services shall be at the rates contained in the applicable Addendum. Termination of this Agreement shall not affect any right or obligations hereunder which shall have previously accrued, or shall thereafter arise with respect to any occurrence prior to termination, and such rights and obligations shall continue to be governed by the terms of this Agreement. 5.5 Termination Due to Material Breach Other Than Non-Payment. Except as set forth in above, in the event that either Physician Group or HNI fails to cure a material breach of this Agreement within | 9 | 0.4314826726913452 | Based on the information provided, the termination date of the line of business specific compensation exhibit is not explicitly stated in the provided excerpts. However, it can be inferred that the termination date is the anniversary date of the Member's Coverage Certificate, if requested by HNI, as stated in section 5.5 of the agreement. | |
| 31 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Type of Contract | 8 4.8 Coordination of Benefits HNI shall conduct Coordination of Benefits in accordance with the policies and procedures in the Operations Manual. Physician Group agrees to promptly notify HNI of any third party entity who may be responsible for payment and collection of Copayments. Physician Group shall not bill Members for any portion of Contracted Services not paid by the primary carrier when HNI is the secondary carrier, but shall seek payment from HNI. When HNI or Payor is secondary under the Coordination of Benefit rules, HNI shall pay Physician Group only those amounts which when added to the amount paid to Physician Group from other sources equals the amount due to Physician Group under this Agreement in the absence of other sources of payments. 4.9 Third Party Recoveries. When HNI has compensated Physician Group for Contracted Services, HNI shall be entitled to recover and retain any amounts due from applicable third party sources for such | 9 | 0.5862761735916138 | I don't know. The contract appears to be related to a physician group, but it does not explicitly state that the contract is for a professional provider. | |
| 32 | 2001-11-01 California Emergency Physicians PSA_MU.pdf | Type of Provider | 21 changes in the availability or location of Covered Services at least 40 days prior to the effective date of such changes. [Knox-Keene Act and PHP Agreement 9. Reports and Information. Physician Group shall provide Health Net, within the time requested by Health Net, with all such reports and information as Health Net may require to allow it to meet the reporting requirements under the PHP Agreement or any applicable law. [22 CCR § 53250(c)(5)] 10. Subcontracting Under the Agreement. Physician Group shall not subcontract for the performance of services under the Agreement without the prior written consent of Health Net. Every such subcontract shall provide that it is terminable with respect to Members by Physician Group upon Health Net request. Physician Group shall furnish Health Net with copies of such subcontracts, and amendments thereto, within ten days of execution. Each such subcontracting Physician Group shall meet Health Net credentialing requirements, | 22 | 0.46529102325439453 | I don't know. The contract does not specify the specific provider types or places of service that are impacted by the contract. |