Asserta Health Inc 10/18/2018 - Laserfiche WebLink

3. Responsibilities of Health Plan. 3.1. Funding. Health Plan shall have the responsibility to provide funds for payment of all Covered Services under its plan. Unless otherwise agreed in writing by the Health Plan's Finance Director,Health Plan will provide funds for payment of a Covered Service by ACH transfer after receipt of an invoice from Asserta for that Covered Service,with such transfer occurring approximately 1-2 business days before the Covered Service occurs. It is expressly acknowledged that Asserta shall have no responsibility or liability for the adequacy of funds to pay for Covered Services or to otherwise pay for Covered Services or fund payments executed via medEcash. 3.2. Notice of Changes and Amendments. Health Plan shall provide Asserta with 10 days prior written notice regarding any changes in its plan documents or procedures in order to allow Asserta sufficient time to adjust its procedures to accommodate such changes and communicate changes to Members. 3.3. Final Authority. Health Plan shall have final authority with respect to payment of all Covered Services. Health Plan may approve each Covered Service prior to Asserta executing cash payment or assessing its service fees. 4. Right Not to Provide Services. Should Health Plan fail to pay Asserta's service fees as reflected in Exhibit A, Fee Schedule,and/or fail to offer an appropriate Shared Savings incentive,or adopt a plan design that establishes Reference Prices that Asserta believes will prevent Asserta from consistently negotiating acceptable Cash Prices, or if Health Plan repeatedly denies authorization for Cash Prices, including Asserta' service fees, that are less than the Reference Price,then Asserta may, at its sole discretion, refuse to provide or cease to provide Services to the Health Plan with advance 15 days written notice. 5. Payment for Services. 5.1. Fees. Health Plan shall pay to Asserta the administrative fees set forth on Exhibit A(the"Fees")which is attached to and made a part of this Agreement.It is agreed and understood that at all times the Plan document of the Health Plan shall dictate payment made to Provider, and that Assert may lower its fees in order to remain within the target Medicare threshold established by the Health Plan. It is understood and acknowledged by Asserta that it will repay any funds transferred to Asserta by the Health Plan or a Member with respect to the Concierge Services should the negotiated service or procedure not occur or if it is delayed and not rescheduled within a time frame acceptable to the Health Plan within 3 business days of notification. Additionally, Asserta will lead the effort to collect from the Provider(s) any prepayments made as part of the negotiation and to coordinate the refund of applicable payments to the Health Plan and Member. 5.2. Printing Costs and Other Expenses. Subject to prior written approval from Health Plan of any such expenditure, Health Plan will reimburse Asserta for all reasonable out-of-pocket expenses incurred by Asserta in connection with the performance of Services hereunder,including without limitation the cost of Health Plan approved printing brochures,announcement materials,and other educational materials. 5.3. Delinquent Payments. All amounts stated on each invoice are due and payable in U.S.dollars upon Health Plan's receipt of the invoice,and are considered delinquent thirty(30)days after the date of the applicable invoice.Undisputed delinquent payments owed to Asserta may bear interest at the rate of one-and-one-half percent per month(or the highest rate permitted by law,if less)from the payment due date until paid in full. Health Plan will be responsible for all reasonable expenses(including attorneys' fees)incurred by Asserta in collecting delinquent amounts, except where such delinquent amounts are due to Asserta's billing inaccuracies. 5.4. Taxes. Health Plan shall be responsible for any duties, customs fees, or taxes(other than Asserta's income tax)associated with the performance of the Services. -3 -