Michael McGuinness
fee71e7740
Feature/postprocessing * tests * passtest * fixshorttests * mosttests * improvingbasedockerfile * testspeeds * testing * host * canparallel * clean * passfullsuite * singlepagemax * test * findfeatures * findstables * tbls * tablestoo * tablestoo * lateraltests * tableloc * cleanup * inlinetable * childids * cleanup * tests
115 lines
5.9 KiB
Plaintext
115 lines
5.9 KiB
Plaintext
Start of Page No. = 1
|
|
|
|
7.14 Status as Independent Entities. None of the provisions of this Agreement is intended to create,
|
|
nor shall be deemed or construed to create any relationship between Provider and All Health or a Payor other than
|
|
that of independent entities contracting with each other solely for the purpose of effecting the provisions of this
|
|
Agreement Neither Provider nor All Health /Payor. nor any of their respective agents, employees or representatives
|
|
shall be construed to be the agent employee or representative of the other
|
|
7.15
|
|
Addenda Each Addendum to this Agreement is made a part of this Agreement as though set
|
|
forth fully herein Any provision of an Addendum that is in conflict with any provision of this Agreement shall take
|
|
precedence and supersede the conflicting provision of this Agreement with respect to the subject matter of the
|
|
Addendum
|
|
7.16 Calculation of Time. The parties agree that for purposes of calculating time under this
|
|
Agreement any time period of less than ten (10) days shall be deemed to refer to business days and any time period
|
|
of ten (10) days or more shall be deemed to refer to calendar days unless the term "business" precedes the term
|
|
"days"
|
|
7.17
|
|
Waiver of Breach The waiver of any breach of this Agreement by either party shall not
|
|
constitute a continuing waiver of any subsequent breach of either the same or any other provision(s) of this
|
|
Agreement Further, any such waiver shall not be construed to be a waiver on the part of such party to enforce strict
|
|
compliance in the future and to exercise any right or remedy related thereto
|
|
THIS CONTRACT CONTAINS A BINDING ARBITRATION CLAUSE, WHICH MAY BE ENFORCED
|
|
BY THE PARTIES
|
|
IN WITNESS WHEREOF the parties have executed this Agreement
|
|
PROVIDER
|
|
ALL HEALTH
|
|
Smith
|
|
Signature
|
|
Health Net Signature
|
|
Peanth
|
|
Harvey
|
|
DUONG MS
|
|
Steve Carrol
|
|
Print Name
|
|
Print Name
|
|
MEDICAL DIRECTOR
|
|
VP Provider Network Management & Strategy
|
|
Title
|
|
Title
|
|
Dummy Group Name Inc.
|
|
Group Name (If Applicable)
|
|
Date
|
|
3/28/2011
|
|
01-2345678
|
|
Tax Identification Number
|
|
Effective Date
|
|
4/15/2011
|
|
2/2/2011
|
|
Date
|
|
California Provider Participation Agreement
|
|
For-Service Direct Network Template
|
|
HN-DN-PPA-11-03-2010
|
|
18
|
|
|
|
This page has 2 signature.
|
|
|
|
|
|
Start of Page No. = 2
|
|
|
|
EXHIBIT A-1
|
|
COMMERCIAL BENEFIT PROGRAMS
|
|
DIRECT NETWORK FEE-FOR-SERVICE
|
|
RATE EXHIBIT
|
|
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E.
|
|
All Health or Payor shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary
|
|
Covered Services delivered under commercial Benefit Programs pursuant to this Addendum, the lesser of (i) the rates
|
|
listed below. or (ii) 100% of Provider's billed charges.
|
|
-------Table Start--------
|
|
[["Category of Service","Compensation"],["Covered Services delivered or arranged by Provider. excluding Laboratory services","95% of CMS Allowable"],["Anesthesia Services when provided by an Anesthesiologist or Certified Registered Nurse Anesthetist (American Society of Anesthesiology (ASA) unit scale)","$39 ASA unit"],["Medical/Surgical Services by an Anesthesiologist or Certified Registered Nurse Anesthetist","95% of CMS Allowable"],["Laboratory Services performed in Provider or Professional Provider office","95% of CMS Allowable"],["Pharmaceuticals","95% of the Average Wholesale Price (AWP)"],["OB Services - CPT 59400: Global Obstetric care with vaginal delivery - CPT 59510: Global Obstetric care with cesarean delivery - CPT 59610: Vaginal Delivery after previous cesarean delivery - CPT 59618: Attempted vaginal delivery, resulting in cesarean","$1,700.00 $1,700.00 $1,700.00 $1,700.00"],["Immunizations","95% of the Average Wholesale Price (AWP) as determined by Health Net."],["General Health Panel - CPT 80050: General Health Panel CPT 80055: Obstetric Panel","$20.00 $15.00"],["By Report (BR) Procedures, Procedures not Listed and Procedures with Relativities not Established","75% of billed charges for Covered Services"]]
|
|
-------Table End--------
|
|
California Provider Participation Agreement
|
|
Fee-For-Service Direct Network Template
|
|
HN-DN-PPA-11-03-2010
|
|
22
|
|
|
|
|
|
Start of Page No. = 3
|
|
|
|
EXHIBIT B-1
|
|
MEDICARE ADVANTAGE PROGRAM
|
|
DIRECT NETWORK FEE-FOR-SERVICE
|
|
RATE EXHIBIT
|
|
I. Payment Rates
|
|
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
|
|
All Health shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered
|
|
Services delivered under Medicare Advantage Benefit Programs pursuant to this Addendum, the lesser of: (i) the rates
|
|
listed below, or (ii) 100% of Provider's billed charges
|
|
-------Table Start--------
|
|
[["Category of Service","Compensation"],["Covered Services delivered or arranged by Provider","100% of CMS Allowable"],["General Health Panel",""],["- CPT 80050 General Health Panel","$20.00"],["- CPT 80055: Obstetric Panel","$15.00"],["By Report (BR) Procedures. Procedures not Listed and Procedures with Relativities not Established","75% of billed charges for Covered Services"]]
|
|
-------Table End--------
|
|
California Provider Participation Agreement
|
|
Fee-Fer-Service Direct Network Template
|
|
HN-DN-PPA-11-03-2010
|
|
27
|
|
|
|
|
|
Start of Page No. = 4
|
|
|
|
EXHIBIT C-1
|
|
MEDI-CAL BENEFIT PROGRAM
|
|
DIRECT NETWORK FEE-FOR-SERVICE
|
|
RATE EXHIBIT
|
|
Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
|
|
All Health shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered
|
|
Services delivered pursuant to this Addendum, the lesser of: 100% of the State of California Medi-Cal Fee Schedule
|
|
rates in effect at the time of service, subject to any adjustments made by the State of California under the applicable
|
|
Medi-Cal Fee-For-Service Program; (ii) Fee-for-service rates for the commercial Benefit Program set forth in
|
|
Addendum A. Exhibit A-1: or (iii) Provider's billed charges.
|
|
California Provider Participation Agreement
|
|
Fee-For-Service Direct Network Template
|
|
HN-DN-PPA-11-03-2010
|
|
34
|
|
|
|
|