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Agreement for Ambulance Transport Billing Services Page 2 of 7 <br /> G. Invoices shall be sent to the Everett Fire Department, 2811 Oakes Ave., Everett, WA 98201. <br /> • IV. RESPONSIBILITIES <br /> A. Systems Design <br /> 1. Systems Design will enter into its computer system all account/patient or medical incident report records <br /> provided by the City. <br /> 2. Systems Design will send invoices or bills for City provided services, at the rates established by the City <br /> and for the services identified by the City. <br /> 3. Systems Design will track charges, payments and adjustments with its computer system. <br /> 4. Systems Design will produce and mail HCFA 1500 forms for all insurance charges entered or transmit <br /> claims electronically to participating insurance companies and agencies. <br /> 5. Systems design will print, stuff and mail private statements no less often than monthly. <br /> 6. Systems Design will produce and deliver monthly reports to the City. Systems Design and the City will <br /> agree upon which reports shall be produced and delivered from the current reports then available in the <br /> Systems Design MMS software. <br /> 7. Systems Design will use reasonable efforts to collect the invoices or bills and shall comply with all <br /> federal and state collection laws. <br /> 8. Systems Design will review all accounts and rebill/followup as necessary. <br /> 9. Systems Design will promptly deposit all payments received by it related to this Agreement in an account <br /> specified by the City. Systems Design may deposit payments to this account, but shall otherwise have no <br /> control or ownership of the account. Systems Design shall institute and maintain a reasonable system of <br /> internal controls with respect to the handling of such payments. The City may audit or investigate such <br /> internal controls and Systems Design shall use its best efforts to cooperate with any audit or investigation. <br /> The City may require Systems Design to institute and maintain additional reasonable internal controls <br /> regarding the handling of payments on City accounts. Copies of all deposit slips will be sent to the City <br /> no less often than monthly. Systems Design shall act as the City's fiduciary with respect to any and all <br /> revenue, money, payments, or collections received by it for the City. <br /> 10. Systems Design will provide Customer Service via toll free phone lines for all patient billing questions <br /> Monday -Friday, 8:00am - 5:00pm Pacific Time (federal holidays excepted). <br /> 11. Systems Design will provide all necessary supplies including insurance forms, private statements, <br /> envelopes and backup diskettes. <br /> 12. Systems Design shall back up all data related to its performance of this Agreement in a commercially <br /> reasonable manner, including off site storage of back up media at regular, and commercially reasonable <br /> intervals, but shall be no less often than monthly. <br /> 13. Systems Design shall comply with all confidentiality and privacy requirements of federal, state and local <br /> law, including, but not limited to, HIPAA (Health Insurance Portability and Accountability Act of 1996, <br /> Pub. L. 104-191, enacted Aug. 21, 1996 (codified at 42 U.S.C. §1320d). Systems Design shall not release <br /> any information provided to it under this Agreement to any source, except to the extent required by <br /> insurance companies or agencies to facilitate payment for claims submitted and as allowed by law. <br /> 14. Systems Design shall commit and utilize sufficient resources to use its best efforts to perform this <br /> Agreement. <br /> 62 <br /> http://mail.systemsdesignnw.com/view.php?Horde=c87c3 5b021 a04ee6a615aad99c4c0d8f&thismai... 3/7/2005 <br />