Laserfiche WebLink
<br />cooperate with RECEIVING AGENCY staff to attain the goals of unified community health <br />assessment, policy development, coordinated services, and quality assurance and to prevent <br />unnecessary duplication of services. <br /> <br />PERFORMANCE MEASURES <br /> <br />The following performance measure(s) will be used to assess, in part, the PERFORMING <br />AGENCY'S effectiveness in providing the services described in this contract Attachment, <br />without waiving the enforceability of any of the other terms of the contract. <br /> <br />At least 25% of the total amount of this Attachment shall be for services provided to Title V <br />eligible individuals through twenty-one (21) years of age by PERFORMING AGENCY. <br /> <br />PERFORMING AGENCY shall provide services to clients who receive services in the following <br />county(ies)/area: Lamar. <br /> <br />SECTION II. SPECIAL PROVISIONS: <br /> <br />General Provisions, Terms and Conditions of Payment Article, is revised to include: <br /> <br />PERFORMING AGENCY'S contract amount under this Attachment is a ceiling against <br />which it may bill, on a fee-for-service basis, for the provision of allowable family <br />planning services to Title V eligible clients. Only allowable services provided to Title V <br />eligible clients may be billed against this ceiling. The current schedule of allowable <br />services and rates, as well as Title V eligibility requirements, may be modified at the sole <br />discretion of RECEIVING AGENCY with thirty (30) days written notice to <br />PERFORMING AGENCY. The notice will provide PERFORMING AGENCY with an <br />opportunity to terminate this Attachment should the modification include a reduction in <br />rates. PERFORMING AGENCY shall have thirty (30) days from receipt of this notice to <br />exercise the option fpr termination. If the PERFORMING AGENCY does not exercise <br />the option during the thirty (30) day time period, PERFORMING AGENCY shall be <br />deemed to have waived the option. <br /> <br />BILLING REQUIREMENTS <br /> <br />PERFORMING AGENCY shall bill RECEIVING AGENCY for allowable services <br />provided to Title V eligible clients. Requests for payment shall be submitted to the <br />Health and Human Services Commission's claims administrator in a manner compatible <br />with the Compass 21 billing system by the 120th day after the date on which services <br />were provided or the date of any third party insurance Explanation of Benefits form. <br />Appeals must be submitted within 180 days of rejection, and all requests for payment <br />shall be submitted within 90 days of the end of the Attachment term. Claims shall be <br />submitted using an approved claim format which follows the RECEIVING AGENCY <br />Family Planning Division billing specifications which may be obtained from <br />RECEIVING AGENCY Family Planning Division. <br /> <br />A TT ACHMENT - Page 2 <br />