07-L(1) Health Contract - Laserfiche WebLink

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