2006-108-RES-DSHS Document NO. 2007-020428, Regional and Local Medical Services

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reimbursement or payment monthly within thirty (30) calendar days following the end of the month covered by the bill. ' Section 4.03 Final Billing Submission. Unless otherwise provided by the Department, Contractor shall submit a reimbursement or payment request as a final close-out bill not later than sixty (60) calendar days following the end of the applicable term for goods received and services rendered during the term. If necessary to meet this deadline, Contractor may submit reimbursement or payment requests by facsimile transmission. Reimbursement or payment requests received in DSHS's offices more than sixty (60) calendar days following the end of the applicable term will be denied. Consideration of requests for an exception will be made on a case-by-case basis subject to the availability of funding. Section 4.04 Working Capital Advance. If allowed under the Contract, a single one- time working capital advance per term of the Contract may be granted at the Department's discretion. Contractor must submit documentation to the Division Contract Management Unit assigned to the Contract to justify the need for a working capital advance. The working capital advance must be liquidated as directed by the Department. The requirements for the documentation justifying the need for an advance and the directions for liquidating the advance are found in the Contractor's Financial Procedures Manual located at http://www.dshs.state.tx.us/contracts. Section 4.05 Financial Status Reports (FSRs). Except as otherwise provided, for contracts with categorical budgets, Contractor shall submit quarterly FSRs to Accounts Payable by the thirtieth calendar day of the month following the end of each quarter of the Contract term for Department review and financial assessment. The final FSR must be submitted not later than 60 days following the end of the applicable term. Section 4.06 Third Party Payors. A third party payor is any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local, and private funding sources. Except as provided in the Contract, Contractor shall screen all clients and shall not bill the Department for services eligible for reimbursement from third party payors. Contractor shall: (a) enroll as a provider in Children's Health Insurance Plan and Medicaid if providing approved services authorized under the Contract that may be covered by those programs, and bill those plans for the covered services; (b) provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs; (c) allow clients that are otherwise eligible for Department services, but cannot pay a deductible required by a third party payor, to receive services up to the amount of the deductible and to bill the Department for the deductible; (d) not bill the Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted; ( e) maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement; (Q bill all third party payors for services provided under this Contract before submitting any request for reimbursement to Department; and (g) provide third party billing functions at no cost to the client. ARTICLE V TERMS AND CONDITIONS OF PAYMENT Section 5.01 Prompt Payment. Upon receipt of a timely, undisputed invoice pursuant to EF29-l2425 General Provisions (Core Subrecipient 2007) Rev. 07/20/2006 Page 8