(a)
(b)
(c)
(d)
(e)
Drafting or specifying all documents, forms and records to be used
by Contracting Providers for their claims of reimbursement and to be
used by HPHC to reimburse them and also to develop procedures
to be utilized in the adjudication of claims;
ATTACHMENT A
ADMINISTRATIVE SERVICES
HPHC shail perform the following administrative services for Purchaser with
. respect to the Plan.
- 4. Financial Systems and Services. HPHC shall establish, administer and
maintain accounting procedures and systems for the preparation of appropriate financial
reports for the efficient management and planning for the Plan. The foregoing shall
include, but not be limited to:
ATTACHMENT LIST
Attachment A Administrative Services
Attachment B Contracting Provider Compensation
Provisions
Attachment C HPHC Compensation Provisions
Attachment D Funding of Covered Services
Attachment E Purchaser's Plan
FORM#PS01 . 05/17/2002
1
ATTACHMENT D
FUNDING OF COVERED SERVICES
OVERVIEW: HPHC shali from time to time, generally at weekly intervals, issue
payment to Contracting Providers for Covered Services. HPHC makes such
payments from a master claims paying account. This Attachment describes the
manner in which the Purchaser provides sufficient funds to HPHC to cover such
payments. Purchaser understands that failure to make sufficient funds available
in accordance with this Attachment shall cause HPHC to suspend further claims.
payments.
ATTACHMENT C
HPHC COMPENSATION PROVISIONS
ATTACHMENT B
CONTRACTING PROVIDER COMPENSATION PROVISIONS
“Care of: ouck rwncl Do] k
Street: aad arn} S
City/State/Zip: . Wt 030 66
iiJHPHG:
The Office of General Counsel
Harvard Pilgrim Heaith Care, Inc.
93 Worcester Street
Wellesiey, MA 02481
3.13 Entire Agreement. This Agreement (together with all attachments) contains the
" entire agreement between the parties relating to the rights granted and the obligations
3.6 Limitations. In the event the operations of HPHC’s facilities or any substantial
portion thereof are interrupted by war, fire, insurrection, labor/provider contract troubles,
millenium failures, riots, the elements, earthquakes or acts of God, the provisions of this
Agreement (or such pertions hereof as HPHC is thereby rendered incapable of performing)
shall be suspended for the duration of such interruption. In the event that this Agreement, or
any portion hereof, is suspended due to HPHC’s inability to operate due to interruptions for
27 Legal Requirements, In the event that any governmental agency determines
that HPHC is operating in Violation of any faw or regulation or otherwise requests that HPHG
cease operations for Purchaser, then this Agreement may be terminated by either partly upon
thirty (80} days written notice.
or order shall remain in effect for sixty (60) days; or
(iv) There exists the issuance of an attachment, garnishment or similar
process against any substantial part of the property of Purchaser and such attachment,
garnishment or other similar process shall not be dismissed within sixty (60) days unless
Purchaser shall contest the validity of such action by appropriate proceedings taken in good
faith within the sixty (60) day period; or
