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THIS AGREEMENT is made and entered into on the day of , 1999 <br />( the "Effective Date") by and between The City of North Olmstead, a <br />("MiJNICIPALITY") , and GREAT LAKES BILLING ASSOCIATES, INC., an Ohio <br />Corporation ("GREAT LAKES"). <br />RF.C'ITAI_S <br />1. The MI1rTICIPALITY is a provider of ambulance service in a <br />MiJNICIPALITY ("The Area")which provides approximately 360 non-resident <br />transports per year. <br />2. GREAT LAKES is a provider of third party ambulance billing services. <br />3. The MiJNICIPALITY desires to obtain and GREAT LAKES is <br />willing to provide billing services for the transports provided by the <br />MUr1ICIPALITY. <br />4. The MiJNICIPALITY is a participating provider in the <br />Medicare program. <br />5. The MiJNICIPALITY bills to the Medicare program under Method 2, as <br />established by the local Medicare Carrier. <br />NOW THEREFORE, in consideration of the mutual covenants and promises <br />hereinafter set forth, and other good and valuable consideration, the receipt and sufficiency of <br />which is hereby acknowledged, the parties agree as follows: <br />RESPONSIBILITIES OF GREAT LAKES BILLING ASSOCIATES, INC. <br />6. GREAT LAKES will utilize its computer system and billing programs to <br />provide billing services to the MLJNICIPALITY, in its ordinary course of <br />business and in conformance with information supplied by the provider. <br />7. GREAT LAKES will provide initial billing processes as needed on an <br />invoice by invoice basis which will include: <br />a. Verification of Billing Information <br />b. Invoice of Transport Utilizing Payer Database and Customer <br />Database. <br />c. Assign appropriate ICD-9 medical codes to invoices. <br />d. Print and Mail Initial Invoice to Responsible Party in lieu of <br />electronic claim submission abilities. <br />e. Submit Electronic and/or Paper Claims to Medicare, Medicaid or <br />other Third Party Payers. <br />2 <br />