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HomeMy WebLinkAbout2002 NS Revenue- Blue Cross and Blue Shield of North Carolina Ambulance Service Contract 3 AMBULANCE SERVICES AGREEMENT 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 ,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 may be 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 venture(r)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. 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 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 Supplies. 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 services are provided under this Agreement,to provide ambulance services to Members. 4 ; 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;(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;and (iii)covered by liability insurance of the type and in the amounts acceptable to BCBSNC. 2.4 Provider Payment and Billing. Provider agrees'that billing and payment by BCBSNC for services to Members shall be as set forth in Exhibit 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 for which the Provider gives the Member notice before rendering the service at issue,provided that the notice specifies that the service may not be covered by BCBSNC or other applicable payer,and that if not covered,then the Member will be responsible for payment; and further provided that the Member agrees in writing before the service is rendered to be responsible for payment of such non-covered service. 2.5 BCBSNC Audit and Inspection. 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. 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,all applicable BCBSNC programs,policies and procedures as may be enacted and revised from time to time. Provider further agrees,upon request,to provide evidence of compliance with the requirements of any and all such BCBSNC programs,policies and procedures. 3. 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. 5 3.2 Processing Claims. To make reasonable efforts to process claims for 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 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 ,20 ,and the term shall continue in effect thereafter for a period of one(1)year. This Agreement shall automatically renew for additional one-year terms,unless terminated sooner by either party as otherwise provided in this Agreement. 4.1 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 Provider 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. 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. 6 8. ENTIRE AGREEMENT/AMENDMENTS. This Agreement and the Exhibits to this Agreement constitute the entire agreement between the parries. 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: 8.1 Exception-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. 8.2 Exception-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. 9. 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. 10. 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. 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 Cross and Blue Shield of Provider North Carolina By: By: (Signature of Representative Duly (Signature of Representative Duly Authorized to Sign This Agreement) Authorized to Sign This Agreement) Print/Type Name: Print/Type Name: Title: Title: 7 EXHIBIT 1 Provider Payment and Billing A. Provider Payment. Consistent with Section 2.4 of this Agreement,Provider agrees Provider shall be paid by BCBSNC as follows: A.1 Usual. Customary and Reasonable(UCR)Reimbursement. For all Traditional and Comprehensive Major Medical(CMM)plans and Preferred Care(CostWise),except Blue Edge as described in Section A.2 of this Exhibit 2.4,BCBSNC agrees to pay and Provider agrees to accept as payment in full for services delivered to Members,Usual,Customary and Reasonable reimbursement as defined in the booklet"Usual,Customary and Reasonable,an Explanation for Doctors". A.2 Charges. For Blue Edge CMM plans,BCBSNC agrees to pay and Provider agrees to accept as payment in full for 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 services delivered to Members,the lesser of Provider's usual charge or the amount specified in BCBSNC's fee schedule.