HomeMy WebLinkAboutMEDALLOCATOR SERVICE AGREEMENT
SERVICES AGREEMENT
This Information Technology Sales and Services Agreement is made and entered into by and between
MedAllocators, Inc (MA) and Augusta-Richmond County.
WHEREAS, MA is in the business of providing MSP reporting/tracking, data capture, archiving, file-
converting, routing, editing and other affiliated services and a web-based clean-up tool to perform such
services; and
WHEREAS, MA and Client desire to set forth in writing their agreement with respect to Client's
engagement of MA to provide such services.
NOW, THEREFORE, in consideration of the mutual promises, commitments, obligations, rights and
benefits set forth herein, the parties hereby agree as follows:
1. Term. The term of the Agreement shall commence on the date hereof and shall be for a one
year (1) period unless and until terminated by either party upon at least a ninety (90) day prior
written notice to the other party. Additionally, MA may terminate this Agreement immediately if
Client fails to make timely payment to MA as described in Section 4.b. Also, either party shall
have the right to terminate this Agreement immediately in the event the other party files or has
filed a petition for bankruptcy, or is determined bankrupt, or if the other party becomes insolvent,
or makes an assignment for the benefits of its creditors, or if a receiver is appointed for all or any
portion of its business assets. Upon termination of this Agreement, each party shall promptly
return to the other, all data, programs, materials, and other properties of the other held by it in
connection with the performance of this Agreement.
2. Services Provided. The services to be provided under this Agreement are as specified in the
attached Exhibit A (the "Services"), pursuant to the terms and conditions of this Agreement. The
parties may, from time to time, amend Exhibit A in a writing signed by an authorized
representative of each party.
3. Rates for Service. The rates for the performance of the Services pursuant to this Agreement shall
be set forth in the attached Exhibit A which is made a part of this Agreement. The rates set forth
do not include any amount for sales, use, excise, or similar taxes which may be imposed by
federal, state or local governments with respect to Services provided pursuant to this Agreement
or products sold or used. If any such taxes are found at any time to be payable, Client agrees to
pay such taxes in addition to the rates for Services.
4. Billing and Payment.
a. Client shall promptly review and approve the invoice. Client's payment shall constitute
acceptance of the quantities, applicable services, travel or other costs. Client shall not
unreasonably withhold approval, but Client shall promptly notify MA of any errors or discrepancies.
All applicable services, travel or other costs on an invoice had to be previously approved by MA
staff.
b. Unless otherwise specified in Exhibit A, MA shall submit to Client a invoice. Client agrees to
pay invoices within fifteen (15) business days of receipt. In the event of termination of this
Agreement, Client shall pay MA for all Services performed prior to and as of the date of
term ination.
5. Removed
6. Independent Contractor Relationship.
a. Client and MA agree that nothing in this Agreement shall be deemed to create an
employment, agency, franchise, joint venture or other relationship between Client and MA for any
purpose. MA shall act at all times as an independent contractor. MA personnel assigned to
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perform the Services for Client are solely the employees of MA or MA's subcontractor's
employees assigned to perform the Services for Client.
b. MA reserves the right to determine the method, manner, and means by which services
will be performed unless otherwise noted in Exhibit A. MA is not required to perform the Services
during a fixed hourly or daily time and if Services are performed at Client's premises, then the
consultant's time spent at the premises by personnel of MA is to be at the discretion of MA subject
to the Client's normal business hours and security requirements.
c. Client shall provide access to or use of its records, documents, computer equipment, and
staff as is reasonably required for the performance of MA's obligations under this Agreement
d. Except to the extent that the MA work must be performed on or with Client's computers or
Client's existing software, all materials used in providing the Services shall be provided by MA.
7. Confidentialitv. MA recognizes that, during the term of this Agreement, MA and its personnel
may have access to confidential or proprietary information of the Client. MA agrees to inform its
personnel that all such confidential or proprietary information disclosed by Client to MA shall
remain strictly confidential. Confidential information shall mean all technical or business
information of a proprietary nature (whether patentable, copyrightable, or otherwise) that at the
time of disclosure to MA is not generally known.
8. Riqhts in Data.
a. All inventions and works of authorship that relate solely to the services provided by MA to
Client which are conceived, made, discovered, written or created by MA personnel alone or jointly
with another person, group or entity other than Client during the terms of this Agreement shall be
considered property of MA. If any inventions or works of authorship do not qualify as a Work for
Hire, MA and its personnel will and hereby do assign to Client, all of their rights, title and interest in
such inventions or works of authorship, including all copyrights and other intellectual and
proprietary rights.
b. Removed
9. Removed
10. Infrinqement of Software. Client warrants and represents that all manufacturer-supplied and other
non-Client-owned software installed by Client has been procured by Client under valid licenses
from the owner of the software and that Client shall not, during the term of this Agreement, be in
default under any such license.
11. Limitation of Liabilitv. MA prides itself on providing quality information technology personnel and
services. Nevertheless, except as provided herein, MA cannot and does not assume any liability
for errors or problems associated with services provided by MA*, and neither MA or its personnel
shall be liable to Client for any loss, liability, damage, cost, or expense of Client (including lost
profit or any other direct, indirect or consequential damages) resulting from, or attributable to,
performance of the Services. MA cannot be responsible for penalties and fines for failure by the
customer to perform but not limited to errors or problems associated with improper data entry,
erroneous data, failure to upload/update required eligibility files/data and failure to supply or edit
response file data in a timely manner. MA neither makes nor intends any express or implied
warranties of any type or description including merchantability and/or fitness with respect to the
Services. Upon the legitimate, non-discriminatory request of Client, MA shall use reasonable
efforts to replace personnel assigned to Client.
· Notwithstanding the foregoing MA will indemnify the Client from any penalties or fees
imposed by CMS for failure by MA to properly report a claim during the Clients assigned
reporting period.
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12. Operations Assistance. MA's work under this Agreement is limited to the Services described in
Exhibit A. To the extent MA is required to work in Client's computer files to perform the Services,
Client is fully responsible for the data and information used by MA and for the day-to-day
operation of their systems, including, but not limited to, making adequate system backups and
verifying accuracy of data. At the request of MA, Client shall make additional backups from time
to time for protection during periods of maintenance, and for the restoring of data, should it
become necessary. Client further agrees to make computer systems available to MA personnel as
reasonably required to adequately provide the services under this Agreement.
13. Governinq Law, This Agreement shall be governed by and construed in accordance with the
laws of the State of Georgia,
14. Notices. All notices which it may be necessary or proper for either Client or MA to give to the
other shall be sent by registered or certified mail, postage prepaid and return receipt requested,
Notice to MA shall be addressed to:
Notice to Client shall be addressed to:
MedAllocators, Inc.
2905 Premiere Parkway, Suite 375
Duluth GA 30097
Attn: Kevin Mahoney
Augusta-Richmond County
530 Greene Street, Room 217
Augusta, GA 30901
Attn: Mayor Deke Copenhaver
15. Assignment. The rights and obligations of the parties shall not be assigned without the prior
written consent of either party. Otherwise, this contract shall be binding upon and shall inure to
the benefit of the parties to this Agreement, and their respective successors and assigns.
16. Amendments, This Agreement may be altered, amended, modified or superseded only in a
writing executed by both of the parties.
17. Force Maieure. The obligations of MA pursuant to this Agreement shall be excused during any
period of delay caused by matters such as strikes, acts of God, raw material or power,
governmental actions, whether voluntary or pursuant to order, or any other matter which is beyond
the reasonable control of MA.
18. Enforcement. Waiver. No waiver of or failure to exercise any option, right or privilege under the
terms of this Agreement by either of the parties on any occasion or occasions shall be construed
to be a waiver of the same or of any other option, right or privilege on any other occasion,
19. Entire Aqreement. This Agreement, together with the Exhibits referenced in the Agreement,
shall constitute the entire agreement between the parties with respect to the subject matter and
supersedes all previous agreements between Client and MA relating to the subject matter of the
Agreement.
20. Severabilitv. Any provision of this Agreement which is prohibited or unenforceable shall be
ineffective to the extent of such prohibition or unenforceability without invalidating the remaining
provisions of the Agreement.
21. Counterparts. This Agreement may be executed in counterparts with an executed counterpart to
be delivered to the other party. Each such executed counterpart shall be deemed an original but
shall constitute one and the same instrument.
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22. Disputes. Any disputes that arise between the parties with respect to the performance of this
Agreement shall be submitted to binding arbitration by the American Arbitration Association to be
determined and resolved by said Association under its rules and procedures in effect at the time
of submission and the parties hereby agree to share equally in the costs of said arbitration,
exclusive of the fees of each party's counsel.
The final arbitration decision shall be enforceable through the courts of the state of a mutually
agreeable state centrally located to minimize travel and expenses for both parties. In the event
that this arbitration provision is held unenforceable by any court of competent jurisdiction then this
Agreement shall be binding and enforceable as if this Section 22 were not part hereof.
23. Misplacement of Consultant. In the event MA places a person with Client who does not perform
the Services in a manner satisfactory to the Client, or who has significant personal relations
issues withthe Client, the Client shall have the right to request immediate removal of the person
by MA. Notwithstanding the foregoing, the removal of personnel of MA pursuant to this Section 23
shall not affect the term of this Agreement provided in Section 1.
24. Non-Exclusive AQreement. Client understands that MA is in the business of providing data
capture, archiving, file-converting, routing, editing, EFT/ERA and other affiliated services and that
it may be and could be performing such services for businesses that compete with Client. This
Agreement shall not prohibit MA from performing such services for such other businesses,
provided that MA does not violate any of the terms of this Agreement. MA is strictly forbidden
from disclosing information on client's customers.
Dated:
J l,t 20)0
MEDALLOCA TORS, INC.
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Dated: ~ :2.l.i, I j 0
I
AUGUSTA-RICHMONDCOUNTY GOV'T
NBY
/' Irs:
Lf2~~.~
Mavor
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MedAllocators will provide Section 111 MSP Reporting services to Auausta-
Richmond County for the following pay per use charges or fees provided that
MedAllocators is recognized as the exclusive provider for any follow up file
actions that the claims may require such as Medicare Set Aside Services (both
Workers compensation and Liability), MCP's, LCP's, Lien
Searches/Determinations and Submisisons with an agreed upon pricing schedule
signed between MedAllocators and Client. Client also agrees that this service is
provided for manually entered claim information only. Medallocators will not
accept EFU's (Electronic File Uploads) for this service.
Small Business Solution Fee Schedule
Setup
Registration
Per Query
Fee
Per Claim
Reported Fee
Testing
Fees
w/COBC
Free
1-10=$50
11-20=$40
21-30=$30
31-40=$20
40-50=$15
50+=$10
$100
(Minimum 1
per quarter)
Free
Dated: l' (Zcrr:J
By:
Its:
Dated: 01/26/10
By:
Its:
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MedAllocators' Rate Structure
MSA Services:
Packal!:e Pricinl!::
$3,500.00-Medicare Set-Aside Allocation (WCMSA), Medicare Lien
Evaluation & Submission *See detailed product description below
$1,875.00-Liability Medicare Set-Aside Allocation (LMSA) and Medicare
Lien Evaluation *See detailed product description below
Standard Pricinl!::
$2,500.00-Workers' Compensation Medicare Set-Aside Allocation (WCMSA)
Provides a comprehensive review and analysis of medical records and payout history,
preparation of WCMSA allocation report by MSCC (14 days TAT) including
determination of current Medicare status. *Prompt Pay Discount $2250.00 (10% prompt pay discount
if received within 14-days;
WCMSA Updates: Free < 90 day. or $125.00/hr > 90 days, or> 1 year standard rates apply
Rush Fees: $375.00/case - Completed MSA within 6 to 10 days
$500.00/case - Completed MSA within 5 days
$900.00-Submission to CMS with Lien Verification:
Submission of MSA Allocation Report including follow-up with CMS. Lien inquiry
initiated.
$1,475.00-Liability Medicare Set- Aside Allocation (LMSA)
Report prepared by MSCC outlining recommendations to protect Medicare's interest at
time of settlement with determination of Medicare status. (Typical review includes
maximum of 50 pages of medical reports).
$1,200.00-Zero Allocation MSA with Submission
This is a request based on legal arguments that the MSA requirement be waived in certain
circumstances. Product is prepared by MedAllocators attorney.
$500.00-Medicare Lien Evaluation (MLE)
Complete Lien investigation and resolution services which may include the following:
lien determination, lien review, lien analysis, MSPRC challenge of any unrelated
conditional payments, obtain final demand and coordinate payment.
$125.00 per hour-Pre-Settlement Lien Negotiation (PLN)
Negotiation with CMS Regional Office to have Medicare Lien reduced or waived.
$175.00-Entitlement Determination
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Determination of current Medicare status (no charge if MSA allocation report requested)
Non-MSA Services:
Care Plan Pricine::
Life Care Plan (LCP) $125.00 per Hour + Expenses (If California based $140.00 per hour)
Certified Life Care Planners identify lifetime future medical and vocational rehabilitation
needs for catastrophic claims. TAT dependent upon availability of client visit and input
from health care providers.
Life Care Plan Review (LCPR) - $125.00 per Hour + Expenses (If California based
$140.00 per hour) Certified Life Care Planners review of completed Life Care Plan to identify
any unnecessary or inflated services/charges for future lifetime needs.
Rush Fees (LCPR):
$375.00/case - MCP rush Fee 6 -10 days (TAT)
$500.00/case - MCP rush Fee <5 days (TAT)
Cost Projection Pricine::
Medical Cost Projection (MCP) - $125.00 per Hour + Expenses (If California based
$140.00 per hour) Certified Life Care Planner review of medical records to provide reserving
tool which outlines future medical/rehabilitation costs for the client's lifetime. Two week
TAT
(MCP) Rush Fees: $375.00/case - MCP rush Fee 6 -10 days (TAT)
$500.00/case - MCP rush Fee <5 days (TAT)
Limited Medical Cost Projection (LMCP) - $1000.00 Flat Rate
Future costs outlined by Medical Professionals (RN' s) used on cases with one year or less
medical treatment or files where client has not had recent extensive medical treatment.
TAT five business days.
Nurse Review Pricine::
Focus Nurse Review- $100.00 per Hour + Expenses (If California based $125.00 per hour)
Review of medical records for specific injury to determine causality or future costs.
Complex Nurse Review (CNR) - $100.00 per Hour + Expenses (If California based
$125.00 per hour) Review of medical records to summarize injury and identify non-related
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treatment. Assists claims professional in getting a true and accurate reflection of the
medical file. Thirty day TAT
Legal Nurse Review (LNR) - $125.00 per Hour + Expenses (If California based $150.00
per hour) Legal Nurse Consultant provides review of interpretation of medical records,
documents and medical-legal issues including causality. Testimony is available. Upon
request can include review of charges for appropriateness/causality to the claim.
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