2009 008 Ordinance - Laserfiche WebLink

Home Browse Search

B. At Client's expense and in Client's name, Client shall establish a fund for the collections from Ambulance Services and elect a banking and deposit method and any lockbox services desired pursuant to Appendix B. Client and Life Force shall coordinate the deposit procedures for the receipt of all monies, correspondence, and documents relating to Client's Ambulance Services. In any event, Client shall forward to Life Force weekly all correspondence, documents, and records of any payments relating to Ambulance Services received directly by Client that week. C. Client shall establish reasonable charges for the Ambulance Services. Client shall be responsible for submitting and maintaining accurate provider enrollment information to Payors. Client shall provide Life Force, in writing, with the following information upon or prior to commencement of Life Force's services and within five (5) days of any changes to such information: Client's Ambulance Services fee schedule, attached hereto as Appendix A, as amended from time to time; 2. The correct name, address, and federal tax identification number of Client; 3. Lists of and copies of Payor contracts; and 4. Any other Client enrollment information, licensures, and certifications, and Authorized Liaison designation. D. Client personnel shall attempt to collect the information sufficient to file a completed claim from the involved parties when the Ambulance Services are provided, but will not delay or withhold treatment/care pending insurance information. Client personnel will attempt to obtain the information to file a completed claim from the receiving hospital if the information was not collected at the scene. E. Client shall at all times be ultimately responsible for obtaining and maintaining appropriate original supporting documentation sufficient for Life Force to meet its duties hereunder, including but not limited to completed copies of the EMS Trip Sheets and Run Reports in Appendix C, substantiation of inedical necessity and the services and level of service rendered, all data elements listed in Appendix D as required for billing, and patient and responsible party information and any signatures, notices, acknowledgements, consents and authorizations as may be necessary to disclose information to Life Force and to authorize payment and claim submission and establish responsible party liability for non-covered services. Client shall submit to Life Force within fifteen (15) days of the date of service copies of all such supporting documentation. F. Client shall respond promptly to all reasonable requests of Life Force relating to supporting documentation and information concerning the Ambulance Services. Client shall provide Life Force, in writing, any additional information as may reasonably be requested by Life Force in order to substantiate an Ambulance Services charge, either on initial submission or upon later inquiry by either the responsible party or a Payor. 4 22068/513664-1