HomeMy WebLinkAbout2005 S Revenue -Blue Cross Blue Shield of North Carolina Ambulance Service Contract~ ~
RETURN THIS COPY TO THE CLERK'S -
AMBULANCE SERVICES AGREl OFFICE FOR THE PERMANENT AGENDA FILE
THIS AMBULANCE SERVICES AGREEMENT (the "Agreement") is entered into effective as
of the Effective Date set forth hereafter in this Agreement, by and between Blue Cross and Blue Shield of
North Carolina, an independent licensee of the Blue Cross and Blue Shield Association, and
Orange County, North Carolina, an ambulance services provider, (`Provider"), (hereafter referred to
collectively as the "parties");
WHEREAS BCBSNC is a hospital, medical and dental service corporation licensed by the State
of North Carolina and/or by such other jurisdictions as maybe required by law or regulation to meet the
obligations set forth in this Agreement; and
WHEREAS Provider is a provider of ambulance services and is duly licensed, registered,.
certified, or otherwise authorized as required by law and regulation, to provide ambulance services in each
jurisdiction in which such services are to be provided under this Agreement; and
WHEREAS the parties to this Agreement seek to facilitate the efficient and cost-effective delivery
of quality ambulance services to individuals covered under health benefit plans or otherwise entitled to
provider network services made available or otherwise administered by BCBSNC;
NOW THEREFORE, the parties, in consideration of the mutual covenants and agreements set
forth herein, do hereby agree as follows:
1. GENERAL DEFINITIONS.
1.1 "BCBSNC" means, as applicable, any one or more of the following: (i) Blue Cross and
Blue Shield of North Carolina; (ii) Personal Care Plan of North Carolina, Inc. ("PCP-NC"); (iii) any
corporate parent, subsidiary or affiliate of BCBSNC and/or PCP-NC; and/or a joint venturer) with
BCBSNC and/or PCP-NC; and/or (iv) any other Blue Cross and Blue Shield plan for purposes of the Blue
Card program or other program coordinated with BCBSNC.
1.2 "Group" means any party that has entered into a contract for health care and/or workers'
compensation coverage and/or the administration of benefits and/or the provision of provider network
services to eligible Members with any of the following: (i) BCBSNC; (ii) another Blue Cross and/or Blue
Shield plan or corporate parent, subsidiary or affiliate thereof; and/or (iii) another health plan which has a
reciprocity or other agreement with BCBSNC.
1.3 "Member" means an individual designated by a Group or by BCBSNC, as the case may
be, to be eligible for health benefit plan coverage and/or benefits and/or provider network services under
BCBSNC's contracts with Groups and individuals.
1.4 "Covered Services" means the benefits and services, goods, equipment and supplies
specified in the Benefit Plan to which Members are entitled in accordance with the terms and conditions
thereof. We may compare the cost-effectiveness of alternative services or supplies when determining which
of the services or supplies will be Covered Services.
2. PROVIDER'S SERVICES AND OBLIGATIONS.
Provider agrees to provide the services and carry out the obligations set forth as follows:
2.1 Member Services. Provider agrees to provide ambulance Covered Services for the
transport of Members in accordance with: (i) all applicable local, state and federal laws and regulations;
(ii) accepted industry standards; and (iii) the terms and conditions set forth in this Agreement.
2.2 Vehicles, Equipment and Sunulies. Provider agrees that all vehicles, equipment,
supplies or other goods used by Provider in carrying out Provider's services and obligations under this
agreement shall be: (i) properly serviced and maintained; (ii) titled, licensed, insured, bonded, registered,
certified, or otherwise authorized as required by each jurisdiction in which Covered Services are provided
under this Agreement, to provide ambulance services to Members.
Document # Fina] Contract 37065-t 5-I l-OS.doc - 8/15/97
2.3 Personnel. Provider agrees that all employees and/or independent contractors or other personnel
designated by Provider to assist in carrying out Provider's duties and obligations under this Agreement shall
be: (i) qualified to perform their designated functions; and (ii) licensed, certified, registered, or otherwise
authorized as required by each jurisdiction in which services are provided under this Agreement to perform
their designated functions Provider presently maintains personal injury liability insurance in the amount of
$1 million per person and $2 million per occurrence and umbrella coverage which provides an additional $4
million of personal injury liability coverage. Provider agrees that it will immediately notify BCBSNC of
any change in the insurance coverage maintained by Provider. If the insurance coverage described
becomes, in the aggregate, less than $1 million per person and $3 million per occurrence, at the option of
BCBSNC, this Agreement may be terminated by BCBSNC upon BCBSNC giving Provider notice of the
termination of this Agreement as provided in Section 5 of this Agreement.
2.4 Provider Payment and Billing. Provider agrees that billing and payment by BCBSNC
for Covered Services to Members shall be as set forth in Ezhibit 2.4 to this Agreement, which is hereby
incorporated by reference into the terms of this Agreement. Provider further agrees that such payment shall
fully discharge BCBSNC, the Member, and all third parties, from any and all liability for Provider's
charges, including, but not limited to, subrogation and workers' compensation, and that Provider shall not,
under any circumstances, bill or otherwise seek payment from BCBSNC, a Member or any third party for
Provider's services rendered, including but not limited to subrogation and workers' compensation.
Notwithstanding the above, the Provider may bill the Member for: (i) any applicable deductible, copayment
or coinsurance; or (ii) any non-Covered Service
2.5 BCBSNC Audit and Inspection. Subject to and consistent with HIPAA privacy laws,
Provider agrees that BCBSNC shall have the right, upon request, to audit, inspect, and copy at reasonable
times and at no additional charge, financial statements, accounting, administrative and medical records, and
any and all other types of records pertaining to or related to the performance and administration of the
services and obligations set forth in this Agreement. Subject to and consistent with HIPAA privacy laws,
Provider further agrees that BCBSNC has the right to use whatever audit methodology it determines
appropriate. BCBSNC's rights set forth in this Section 2.5 shall survive termination of this Agreement.
2.6 BCBSNC Independent Licensee of Association. Provider acknowledges its
understanding that this Agreement constitutes a contract between the Provider and BCBSNC, that BCBSNC
is an independent corporation operating under a license from the Blue Cross and Blue Shield Association,
an association of independent Blue Cross and Blue Shield plans (the "Association") permitting BCBSNC to
use the Blue Cross and/or Blue Shield service mark in the State of North Carolina, and that BCBSNC is not
contracting as the agent of the Association. Provider further acknowledges and agrees that it has not
entered into this Agreement based upon representations by any person, entity, or organization other than
BCBSNC and that no person, entity or organization other than BCBSNC shall be held accountable or liable
to the Provider for any of BCBSNC's obligations to Provider set forth in this Agreement. This Section 2.6
shall not create any additional obligations whatsoever on the part of BCBSNC other than those obligations
set forth under other provisions of this Agreement.
2.7 Compliance With BCBSNC Policies and Procedures. Provider agrees to comply
with, and abide by the decisions of BCBSNC with respect to claims. Provider agrees to comply with and
abide by all applicable BCBSNC programs, policies and procedures as maybe enacted and revised from
time to time so long as Provider has prior notice of all such applicable BCBSNC programs, policies and
procedures. Provider further agrees, upon request, to provide evidence of compliance with the requirements
of any and all such BCBSNC programs, policies and procedures.
Document # Final Contract 37065-1 5-11-OS.doc - 8/15/97
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BCBSNC'S OBLIGATIONS.
BCBSNC agrees either to perform, or to have performed by an authorized representative/agent, the
following obligations:
3.1 Administrative Functions. Provide administrative, accounting, database management,
reporting, and other functions necessary to the administration and performance of its obligations under this
Agreement.
3.2 Processing Claims. To make reasonable efforts to process claims for Covered Services
rendered by Provider to Members within thirty (30) days of BCBSNC's receipt of all information necessary
to process such claims.
3.3 Payment For Services. To pay Provider for Covered Services rendered to Members in
accordance with the provisions of Section 2.4 and Exhibit 2.4 to this Agreement.
4. TERM AND TERMINATION.
4.1 Effective Date and Term. This Agreement shall be effective as of the Effective Date,
which shall be the ~ day of ,~ol~S ,and the term shall continue in effect thereafter for a
period of one (1) year. This Agreeme t shall automatically renew for additional one-year terms, unless
terminated sooner by either party as otherwise provided in this Agreement.
4.2 Termination With or Without Cause. Either BCBSNC or Provider may terminate this
Agreement at any time, with or without cause, upon prior written notice to the other party of not less than
ninety (90) days. .
5. NOTICES.
5.1 Method of Delivery. Any notice to be given under this Agreement shall be in writing,
addressed to the other party at the address listed in Section 5.2, or such other address as the party may
designate by notice to the other party, and shall be deemed given by in-person hand-delivery, or by
depositing such notice for delivery with the United States Postal Service, certified mail, return receipt
requested, postage prepaid.
5.2 Addresses. The parties' names and addresses for purposes of giving notice under this
Agreement shall be as follows:
BCBSNC
Vice President of Network Management
P.O. Box 2291
Provider:
Durham, NC 27702
6. INDEPENDENT CONTRACTORS.
Neither party to this Agreement nor their respective employees or agents shall be deemed to be an
agent, employee or servant of the other party. The parties acknowledge and agree that the relationship
between them shall be that of independent contractors.
Document # Final Contract 37065-1 5-11-OS.doc - 8/15/97
7. ASSIGNMENT/SUBCONTRACTING.
7.1 Provider. Provider shall not assign, subcontract, delegate, or otherwise transfer this
Agreement and/or any of Provider's services and obligations under this Agreement, without the prior
written consent of BCBSNC. The parties agree that upon any such assignment, subcontract, delegation or
other transfer by Provider, BCBSNC shall have the right to terminate this Agreement immediately upon
notice to Provider.
7.2 BCBSNC. BCBSNC shall give Provider prior written notice of any assignment,
subcontract, delegation or other transfer of this Agreement or any of BCBSNC's duties or obligations under
this Agreement.
8. PATIENT CONFIDENTIALITY.
BCBSNC and Provider agree that all Member medical records, personal information and other
applicable health records will be treated as confidential as required by state and federal law, including but
not limited to Article 39 of Chapter 58 of the North Carolina General Statutes, or successor thereto. Both
parties agree to maintain written policies and procedures, which address protection of patient
confidentiality.
9. ENTIRE AGREEMENT/AMENDMENTS.
This Agreement and the Exhibits to this Agreement constitute the entire agreement between the
parties. No amendment to this Agreement shall be effective unless in writing, signed by both parties, with
the exceptions set forth in this Section 8 as follows:
9.1 Eaceution - Changes in Law. In the event that BCBSNC determines that federal
and/or state law or regulation requires amendments to this Agreement, then BCBSNC shall give Provider
thirty (30) days prior written notice, and upon expiration of such 30-day period, this Agreement shall be
automatically amended to include the amendments set forth in BCBSNC's notice.
9.2 Exceation -Provider Payment. In the event that BCBSNC determines that changes in
this Agreement are appropriate, then BCBSNC shall give Provider written notice not less than 90 days prior
to the effective date of such changes. Upon expiration of such 90-day period, the changes set forth in
BCBSNC's notice shall automatically take effect.
10. GOVERNING LAW.
This Agreement shall, in all instances and under all circumstances, be governed by and construed
in accordance with the laws of the State of North Carolina, excluding its choice of law and/or conflicts of
law provisions. The parties hereby consent and agree that the venue for any legal action under or relating to
this Agreement shall be either Durham or Orange County, North Carolina.
11. THIS AGREEMENT SUPERSEDES ALL OTHERS BETWEEN THE PARTIES.
The parties acknowledge and agree that this Agreement supersedes any and all other agreements
between the parties regarding the same or similar services, and that all such other agreements between the
parties are rendered null and void as of the Effective Date set forth above in this Agreement.
Document # Final Contract 37065-1 5-11-OS.doc - 8/15/97
IN WITNESS WHEREOF, each party to this Agreement has caused its duly authorized
representative to sign this Agreement on its behalf below, effective as of the Effective Date set forth above
in this Agreement.
Blue Cro and Blue Shi d of
North ro W
By: /~/
( ignature of Representative Duly
Authorized to Sign This Agreement)
Print/T'ype Name: MNo M. Braaicli
Vice Preslde::t
Title:
Document # Final Contract 37065-1 5-11-OS.doc - 8/15/97
Print/Type Name:
EXHIBIT 2.4
Provider Payment and Billing
A. Provider Pam Consistent with Section 2.4 of this Agreement, Provider agrees Provider
shall be paid by BCBSNC as follows:
A.i Char es. For CMM plans, BCBSNC agrees to pay and Provider agrees to accept as
payment in full for Covered Services delivered to Members, usual billed charge.
A.2 Fee Schedule. For all Health Maintenance Organization (HMO), Point of Service
(POS) and Preferred Provider Organization (PPO) plans, except Preferred Care (CostWise), BCBSNC
agrees to pay and Provider agrees to accept as payment in full for Covered Services delivered to Members,
the lesser of Provider's usual charge or the amount specified in BCBSNC's fee schedule.
Document # Final Contract 37065-1 5-11-OS.doc - 8/15/97
Linda Strickland -Revised Fee Schedule Disclosure 5-3-05.x1s
BCBSNC Fee Schedule Disclosure
Orange County EMS
Code Fee
0425 $6.29
0426 $223.97
0427 $354.64
0428 $186.65
0429 $298.63
0432 $326.63
0433 $513.28
0434 $606.60
0435 $7.56
0436 $20.14
3019 $298.63
Q3020 $186.65
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Labs, HCPCS, and therapy codes are based on the BCBSNC statewide fee schedule
Claims are paid at the lesser of charge or fee schedule
accept the reimbursement a~ indicated above.
Signature! f/Vt/jf/~'(i6`r C./ov `~~
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