2014 002 Ordinance - Laserfiche WebLink

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Unless the waiver of a responsible parly or Resident financial obligation would result in a Client service not being covered by insurance or a benefit plan, Life Force shall not bill and attempt collections for individuals located in Client's jurisdiction who substantiate their residency status based on reasonable criteria established by Client ("Residents"). Life Force will bill and attempt collections from Non-Residents for applicable co-pays and deductibles unless covered by secondary insurance. PLEASE ATTACH COPY OF O1tDINANCE/LEGISLATIO11oT. Definition of Resident Client will be responsible for determining the Resident and Non Resident status before submitting the trip to Life Force, obtaining documentation to substantiate residency status, and selecting the informational statements received by Residents. In some cases, the information obtained from the receiving hospital may be used by Life Force to determine the patient's residency. Client will include the following individuals in its definition of Resident status: (PLEASE INITIAL ALL APPLICABLE) X Individuals with a permanent legal residence (residence of record) within the jurisdiction of Client. The residency category of a minor is determined by the residency of their parent or legal guardian. Individuals einployed by tax-paying Employers within the jurisdiction of Client. For mutual aid calls, Client elects to have Life Force do one of the following: treat the patient as a Non-resident. X follow the billing procedures established by the community in which the person transported resides as instructed by Client on the trip report. Billing of Non-Residents X Pursuant to Section 1(C)(4), Client directs Life Force to handle Non-Resident "insurance only" billing and collections as follows: a. Generallv. Life Force will send Non-Residents a request for uisuraiice letter indicating that Life Force will submit the claim to the Non-Resident's Payor but that the Non-Resident is responsible and should pay directly any co-pay and/or deductible. If the Non-Resident does not have coverage or the Payor does not pay the invoiced amount, Life Force will submit the information to the Client for further instruction. If the Non-Resident does not respond to the communication from Life Force, the Non-Resident will be considered non-insured and the account will be submitted to the Client for further instruction. Life Force is not authorized to automatically adjust Non-Resident accounts according to this Non- Resident collection policy but is required to provide Client with a listing of those accounts and ask for further instruction from the Client. Life Force is authorized to automatically adjust Non-Resident accounts according to this Non-Resident collection policy and provide Client with a listing of these accounts each month. iii