Okaloosa County BOCC — October 15, 2013 — ADPI 3rd Contract Amendment — reading text

writing and sent to the other party as directed below or as otherwise directed by either party, from time to time, by written notice to the other. All such notices shall be deemed validly given upon receipt of such notice by certified mail, postage prepaid, facsimile transmission, e-mail or personal or courier delivery: Page 9 of 12 18. Exhibit A If to Covered Entity: Okaloosa County EMS 90 College Boulevard East Niceville, FL 32578 Attn: Dino J. Villani, Public Safety Director Telephone no: 850-651-7150 Facsimile no: 850-651-7170 If to Business Associate: Advanced Data Processing, Inc. 6451 N. Federal Highway, Suite 1000 Ft. Lauderdale, Fl 33308 Attn: Gregg Bloom, Chief Compliance Officer Telephone no: 954-308-8702 Facsimile no: 954-308-8725 The following services to be performed by Business Associate require Business Associate to access, create and use PHI on behalf of Covered Entity in accordance with the Agreement: a. Prepare and submit initial claims and bills for Covered Entity promptly upon receipt thereof, and prepare and submit secondary claims and bills promptly after identification of the need to submit a secondary claim. Assist Covered Entity in identifying necessary documentation in order to process and bill the accounts. Direct payments to a lockbox or bank account designated by Covered Entity, to which Covered Entity alone will have signature authority. Pursue appeals of denials, partial denials and rejections when deemed appropriate by Business Associate. Respond to and follow up with payors and respond to messages or inquiries from a payor. Provide appropriate storage and data back-up for records pertaining to Covered Entity’s bills and collections, accessible to Covered Entity at reasonable times. Maintain records of services performed and financial transactions. Meet, as needed, with representatives of Covered Entity to discuss results, problems and recommendations. Page 10 of 12 Exhibit A Provide any Covered Entity-designated collection agency with the data necessary for collection services to be performed when an account is referred to such agency. Support the provider in filing and maintaining required documentation and agreements with commonly-used payors (e.g., Medicare, Medicaid, Champus, etc.). Provide reasonably necessary training periodically, as requested by Covered Entity, to Covered Entity’s emergency medical personnel regarding the gathering of the necessary information and proper completion of run reports. Utilize up-to-date knowledge and information with regard to coding requirements and standards, to comply with applicable federal, state and local regulations. Provide a designated liaison for Covered Entity, patient and other payor concerns. Provide a toll free telephone number for patients and other payors to be answered as designated by Covered Entity. Facilitate proper security of confidential information and proper shredding of disposed materials containing such information. Establish arrangements with hospitals to obtain/verify patient insurance and contact information. Respond to any Covered Entity, payor or patient inquiry or questions promptly. Maintain appropriate accounting procedures for reconciling deposits, receivables, billings, patient accounts, adjustments and refunds. Provide reasonable access to Covered Entity for requested information in order for Covered Entity to perform appropriate and periodic audits. Provide timely reports facilitating required aspects of monitoring, evaluating, auditing and managing the services provided. Process refund requests and provide Covered Entity with documentation substantiating each refund requested. Page 11 of 12 Exhibit A aa. bb. cc. Assign billing to patient account numbers providing cross-reference to Covered Entity’s assigned transport numbers. Maintain responsibility for obtaining missing or incomplete insurance information. Provide accurate coding of medical claims based on information provided by Covered Entity. Negotiate and arrange modified payment schedules for individuals unable to pay full amount when billed. Retain accounts for a minimum of six (6) months (unless otherwise specified by mutual agreement) and after six (6) months turn over accounts for which no collection has been made (unless insurance payment is pending) to an agency designated by Covered Entity. Permit real-time read only electronic look-up access by Covered Entity to Business Associate’s billing system and SaaS Service, if applicable, to obtain patient data and billing information. Maintain records in an electronic format that is readily accessible by Covered Entity personnel and that meets federal and state requirements for maintaining patient medical records. If Covered Entity has purchased Business Associate's TripTix® product, Business Associate shall provide TripTix® based reporting extract of data required by state or local regulatory authorities connectivity/interface in a format reasonably required by such authorities. Page 12 of 12