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125 lines
6.3 KiB
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125 lines
6.3 KiB
Plaintext
Document Index
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EXHIBIT A-1 2
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COMMERCIAL BENEFIT PROGRAMS 2
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DIRECT NETWORK FEE-FOR-SERVICE 2RATE EXHIBIT 2
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MEDICARE ADVANTAGE PROGRAM 3DIRECT NETWORK FEE-FOR-SERVICE 3RATE EXHIBIT 3
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I. Payment Rates 3
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MEDI-CAL BENEFIT PROGRAM 4DIRECT NETWORK FEE-FOR-SERVICE 4RATE EXHIBIT 4
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Start of Page No. = 1
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7.14
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Status as Independent Entities. None of the provisions of this Agreement is intended to create,
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nor
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shall be deemed or construed to create any relationship between Provider and All Health or a Payor other than
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that of independent entities contracting with each other solely for the purpose of effecting the provisions of this
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Agreement. Neither Provider nor All Health /Payor, nor any of their respective agents, employees or representatives
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shall be construed to be the agent, employee or representative of the other.
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7.15
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Addenda. Each Addendum to this Agreement is made a part of this Agreement as though set
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forth fully herein. Any provision of an Addendum that is in conflict with any provision of this Agreement shall take
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precedence and supersede the conflicting provision of this Agreement with respect to the subject matter of the
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Addendum.
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7.16
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Calculation of Time. The parties agree that for purposes of calculating time under this
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Agreement, any time period of less than ten (10) days shall be deemed to refer to business days and any time period
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of ten (10) days or more shall be deemed to refer to calendar days unless the term "business" precedes the term
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"days".
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7.17
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Waiver of Breach. The waiver of any breach of this Agreement by either party shall not
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constitute a continuing waiver of any subsequent breach of either the same or any other provision(s) of this
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Agreement. Further, any such waiver shall not be construed to be a waiver on the part of such party to enforce strict
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compliance in the future and to exercise any right or remedy related thereto.
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THIS CONTRACT CONTAINS A BINDING ARBITRATION CLAUSE, WHICH MAY BE ENFORCED
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BY THE PARTIES.
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IN WITNESS WHEREOF, the parties have executed this Agreement.
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PROVIDER
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ALL HEALTH
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Smoke
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Signature
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Health Net Signature
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Harvey
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DUONG M.S.
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Steve Carrol
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Print Name
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Print Name
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MEDICAL DIRECTOR
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VP Provider Network Management & Strategy
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Title
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Title
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Dummy Group Name, Inc.
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Group Name (If Applicable)
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Date
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3/28/2011
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01-2345678
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Tax Identification Number
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Effective Date
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4/15/2011
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2/2/2011
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Date
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California Provider Participation Agreement
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18
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Fee-For-Service Direct Network Template
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HN-DN-PPA-11-03-2010
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This page has 2 signature.
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Start of Page No. = 2
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EXHIBIT A-1
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COMMERCIAL BENEFIT PROGRAMS
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DIRECT NETWORK FEE-FOR-SERVICE
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RATE EXHIBIT
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Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
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All Health or Payor shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary
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Covered Services delivered under commercial Benefit Programs pursuant to this Addendum, the lesser of: (i) the rates
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listed below, or (ii) 100% of Provider's billed charges.
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California Provider Participation Agreement
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22
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Fee-For-Service Direct Network Template
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HN-DN-PPA-11-03-2010
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-------Table Start--------
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7436be95-25d1-41ad-9abb-1d9e85b85440
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[['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']]
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DIRECT NETWORK FEE-FOR-SERVICE RATE EXHIBIT
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-------Table End--------
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Start of Page No. = 3
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EXHIBIT B-1
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MEDICARE ADVANTAGE PROGRAM
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DIRECT NETWORK FEE-FOR-SERVICE
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RATE EXHIBIT
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I. Payment Rates
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Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
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All Health shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered
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Services delivered under Medicare Advantage Benefit Programs pursuant to this Addendum, the lesser of: (i) the rates
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listed below, or (ii) 100% of Provider's billed charges.
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California Provider Participation Agreement
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27
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Fee-For-Service Direct Network Template
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HN-DN-PPA-11-03-2010
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-------Table Start--------
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[['Category of Service', 'Compensation'], ['Covered Services delivered or arranged by Provider', '100% of CMS Allowable'], ['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']]
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None
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-------Table End--------
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Start of Page No. = 4
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EXHIBIT C-1
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MEDI-CAL BENEFIT PROGRAM
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DIRECT NETWORK FEE-FOR-SERVICE
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RATE EXHIBIT
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Subject to the terms of this Agreement, including without limitation the Payment Conditions set forth in Addendum E,
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All Health shall pay and Provider shall accept as payment in full for non-capitated Medically Necessary Covered
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Services delivered pursuant to this Addendum, the lesser of: 100% of the State of California Medi-Cal Fee Schedule
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rates in effect at the time of service, subject to any adjustments made by the State of California under the applicable
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Medi-Cal Fee-For-Service Program; (ii) Fee-for-service rates for the commercial Benefit Program set forth in
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Addendum A, Exhibit A-1; or (iii) Provider's billed charges.
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California Provider Participation Agreement
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34
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Fee-For-Service Direct Network Template
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HN-DN-PPA-11-03-2010 |