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• <br /> Attachment B <br /> FEES <br /> The fees to be paid associated with the successful generation of incremental Medicaid revenues <br /> as a result of the Ground Emergency Medical Transport(GEMT)program are calculated based <br /> on total number of Annual Medicaid Trips and detailed in the table below. Fees are based on <br /> paid revenues per annual cost report submission and corresponding true-up, and includes <br /> enhanced incremental revenues received from the GEMT program(Medicaid Fee-for-Service <br /> and Medicaid Managed Care). <br /> Annual Medicaid Fixed Fee Cost Contingency Fee <br /> Trips per Submission Option <br /> 1-60 $7,500 N/A <br /> 61-180 $20,000 15% <br /> 181+ $30,000 15% <br /> As notated in the above model,providers with more than 60 annual Medicaid Trips have the <br /> option of electing to pay the Fixed Fee Cost per Submission, or the 15%Contingency,per annual <br /> cost report submission and corresponding true-up, inclusive of enhanced incremental revenues <br /> received from GEMT program. <br /> received from the GEMT program shall bepaid in full directlyto <br /> The fees based on revenues p gr <br /> SYSTEMS DESIGN within thirty(30) days of receipt of funds by the City. Invoicing will occur <br /> only after HCA"true-up" is completed in full. The City will remit payment to Systems Design <br /> within thirty(30)days of invoice receipt. <br /> Page 4 <br />