Enrollment Service Schedule
1. Enrollment Services. Subject to the terms of this Enrollment Service Schedule, if Customer has purchased the Enrollment Services, Company shall provide to Customer Company’s Enrollment Services, which includes (i) application preparation for the purposes of admittance to Networks, (ii) attachment of relevant boilerplate provider agreement documents, (iii) presentation of documents and directions for Customer or Provider review and Customer or Provider execution, (iv) submission of executed documents to identified Networks, (v) tracking and reporting of submitted applications and of participation status, (vi) population, submission and follow-up for delegated enrollment (where applicable), and (vii) maintenance of online shared databases for plan credentials access (including CAQH updates). This Service Schedule is subject to the terms and conditions of the Agreement.
a. “Networks” means (i) managed care (HMO, PPO, POS, Indemnity) networks, (ii) specialty networks, (iii) self-insured employer/union panels, (iv) Medicare Choice + networks, (v) managed Medicaid networks, (vi) Independent Practice Associations, (vi) Medicare, (vii), Medicaid and (viii) Healthcare exchange networks.
b. “Providers” means the Customer’s (i) employed or contracted Physicians, Nurse Practitioners, Physician Assistants, allied health practitioners and behavioral health practitioners; (ii) licensed facilities; and (iii) ancillary practice locations with equipment subject to separate applications and quality review.
c. “Group” means the professional practice of Providers incorporated under a professional corporation or similar structure, which provides either single or multiple specialties and which is the party to this Agreement. Group may also mean an umbrella structure comprised of multiple Providers (faculty practice plan, entity owning multiple practices, etc.).
3. Obligations of Customer.
a. Presentation of Supporting Materials. Customer shall present Company with all requested enrollment information and materials applicable to Customer and Providers for enrollment purposes. Materials shall be accurate, truthful, complete, current, legible, of sufficient quality to scan and photocopy and not modified or written upon. Customer shall retain original documents or copies of all documents submitted to Company.
b. Verification and Maintenance of Provider Credentials. Customer shall be responsible for verification of information and materials submitted to Company. Customer shall, or shall insure that Provider shall, initiate renewal of Provider licensure, certification, registration and continuing medical education required for admittance to Networks. Customer shall respond to Company’s requests for renewal documents in a timely manner to ensure ongoing Network participation. Customer shall ensure that changes to Provider practice status, malpractice information, or any other relevant demographics are reported to Company for subsequent application and re-enrollment activities.
c. Original Provider Execution. Customer shall ensure that Provider’s original signature and date of signature is affixed to Network applications and agreements when requested. Signature stamps are not considered acceptable by Networks and must not be used. No person may sign on behalf of Provider unless the application and agreement is for an ancillary practice location or group practice in which case an authorized person or officer of the facility may sign.
d. Selection of Networks. Customer shall submit to Company a list of Networks with which to apply. Networks may be added at any time for all or a subset of Providers within the Customer’s Group, if applicable.
e. Network Contracts and Reimbursement Schedules. Unless otherwise agreed to by the Parties, Customer is responsible for review of each Network’s boilerplate agreement, fee schedules and attachments. If Customer has negotiated language modifications or fee schedule enhancements with a Network(s), Customer must notify Company of such modifications or enhancements in writing prior to Company’s submission of enrollment applications to the respective Network(s).
f. Provider Additions/Deletions. Customer must notify Company of additional Providers and promptly submit enrollment materials for such additional Providers in their entirety to Company. Company will not initiate Network application production unless sufficient materials are received from Customer and are in usable condition. Customer must notify Company of physicians departing from Customer’s Group with an effective date for the purposes of responding to re-enrollment requests.
g. Customer Practice Information. Customer must notify Company of any changes in information presented to Company including, but not limited to, hours of operation, TIN, address, or name of administrator.
h. Provider Participation Mailings and Network Documents. Customer acknowledges that Networks may call, email, mail or fax information directly to Provider or Customer. For Company to successfully track application progress to completion, Customer agrees to promptly forward to Company any messages, faxes and copies of mailings from Networks related to application status and participation. Customer is responsible for retaining original Network agreements and other documents.
4. Obligations of Company.
a. Application Preparation. Upon receipt of all requisite enrollment information from Customer, Company shall produce applications for Providers or Customer’s Group(s) to participate in Networks selected by Customer. Such applications will include the enrollment information provided by Customer and Company will not verify Provider credentials or attest to their accuracy. Completed applications shall be delivered to Customer Liaison for execution by Provider or a Group representative in accordance with Section 3(c). Customer acknowledges that executed applications returned without requested information or signatures will be returned to Customer Liaison and may not be submitted.
b. Application Submission and Follow-up. If requested, complete applications will be submitted to Networks and will designate Company to respond to questions about the application. Company will call Networks to verify receipt of and to track applications. Customer acknowledges that Network enrollment procedures and timeframes are not within the control of Company.
c. Delegated Rosters. Where Customer maintains delegated enrollment arrangements with Networks, Company shall maintain and, on a monthly basis submit, delegated rosters containing new Providers, Provider changes, Provider deletions and Customer’s Group changes. This delegated roster process replaces the application submission process where applicable.
d. Reports. Company shall provide tracking and standard reports to Customer on Provider status, application progress and Provider number status as needed.
e. Scheduled Meetings. Company and Customer will meet regularly to discuss the Enrollment Services. The frequency and format of such meetings will be determined jointly by Company and Customer.
a. Fees. In consideration for the Enrollment Services provided Company hereunder, Customer shall pay Company at the rates set forth in the Order Form.
b. Special Projects/Services. Special Projects/Services not included in the Enrollment Services are not included Fees above and are billed at hourly rates ranging from $100/hour to$350/hr, depending on the level of complexity and staff required.
6. Term and Termination.
a. Early Termination Fee. In the event that Customer terminates this Enrollment Service Schedule in accordance with Early Termination provisions of the General Terms and Conditions, Customer agrees to pay an early termination fee equal to the Per Provider Per Month Fee times the number of Providers times the number of months remaining in the then current Term. Customer agrees that Company’s losses in the event of early termination will be difficult to ascertain, that the Enrollment Fees were based upon Customer completing the full term of the Service Schedule, this Early Termination Fee is compensation to Company for loss of the contractual bargain between Customer and Company, and the Early Termination Fee is merely intended to establish a reasonable approximation of Company’s losses and is not a penalty imposed on Customer. This Section shall survive termination of the Service Schedule and Agreement.
b. Obligations Upon Termination. Upon termination of this agreement, Company shall return or destroy any copies of Provider and Customer information (electronic and paper) in its possession. Company shall redirect requests for information by Networks to Customer.
7. Disclaimers. Customer understands and agrees that Company is not responsible for Network decisions on Customer or Provider inclusion due to (i) Provider credentials, (ii) Network need, (iii) expiration of enrollment materials following a minimum of three (3) documented Company requests for current information or materials, or (iv) Network discovery of information during the credential verification process which was not disclosed to Company. Further, Customer understands and agrees that Company is not responsible for denial of payment by Networks for non-credentialed Providers or by errors by Networks in acknowledging the participation status of a Provider as communicated to and represented by Company.