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BILLING SERVICES AGREEMENT <br />THIS AGREEMENT ("Agreement'), effective this <br />between <br />day of , 19_ is by and <br />("Customer) and VALLEY PHYSICIANS SERVICES, INC. <br />("Valley'). <br />SECTION I- RELATIONSHIP OF THE PARTIES. Vailey is in the business of providing billing and <br />collection Services to the health care industry. This Agreement sets forth an independent contractor <br />relationship between Valley and Customer. <br />SECTION 2 - SERVICES. <br />(A) Valley's obligations - Valley shall provide the following Services for the Services of <br />Customer ("Services"): <br />(1) Valley shall render the initial bill for Services upon receipt of all necessary billing <br />information. <br />(2) Valley shall, upon receipt of all necessary billing information, prepare and submit <br />claims for Services to thircl-party payors, which shall include electronic claims <br />processing when appropriate and available. <br />(3) Valley shall mail a statement of account to all patients of Customer who do not <br />have insurance. <br />(4) Valley shall rebill an account which is past due until such time as it is deemed <br />necessary by Valley for the account to be submitted for collection. <br />(5) Valley shall post payments to individual patient account records. <br />(6) Valley shall deposit all collections for Services to a separate account in <br />Customer's name, not more than five (5) banking days after such funds are <br />received by Valley. Valley shall supply duplicate deposit records to Customer on <br />a weekly basis. <br />(7) Valley shall provide reasonable Customer assistance Services, according to the <br />standards and practices of Valley, with respect to matters which arise in the <br />ordinary course such as patient telephone or written inquiries directed to Valley <br />and insurance claim form processing. <br />(8) Valley shall, utilizing funds of the Customer, provide refunds to third-party <br />payors and patients when overpayments occur. <br />(9) Valley shall supply the various reports delineated in Section 3 below. <br />r- x 1A Ii? 1 T"A't <br />