CLIENT provides countywide ambulance and medical services some of which will qualify for the PEMT Program for Medicaid. CLIENT must comply with both U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act and as such, PCG shall comply.
B. CLIENT provides emergency medical transports to Medicaid patients each year and the
Contractor shall complete the required paperwork for CLIENT to participate in the PEMT Program.
C. This PEMT Program provides for supplemental payments for allowable costs that are in excess of other Medicaid revenue received for emergency medical transportation services to Medicaid eligible recipients.
D. PCG shall be familiar with the PEMT Program in the state of Florida and all the rules, regulations and requirements associated with the Program.
E. PCG shall have the knowledge, skills, and ability to fully complete the required cost reports to the Agency for Health Care Administration (AHCA) within the time frame prescribed by AHCA.
F. PCG shall have knowledge of the data and cost reporting principles specified in Chapter 40 I, Florida Statutes.
G. PCG shall have knowledge and experience in the completion of all ten ( 10) Schedules as required by the Program.
H. CLIENT will provide PCG with all of the required data needed to complete the Schedules; however, PCG is responsible for accurate completion of the Schedules.
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Okaloosa County EMS PCG Emergency Services Agreement Solutions that Matter
I. PCG shall be able to accept from CLIENT, in electronic submission form, all information
via a secure connection in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
J. If the completed cost report is rejected by AHCA, PCG shall work with CLIENT to make the necessary corrections and/or modifications and resubmit the report before the required filing deadline.
K. PCG shall keep CLIENT informed of all updates relating to managed care and estimate the impact of future changes in managed care reimbursement.
L. PCG shall support CLIENT in establishing the legal and operational ground to participate in the Managed Care program.
M. PCG shall draft supporting documentation and flow processes for presentation to CLIENT
and assist with messaging and review presentations for governmental relationship staff as needed.
N. PCG shall provide guidance and support to CLIENT for it to enter into contracts with Managed Care Organizations.
0. PCG shall be familiar with the Managed Care program in the state of Florida and all the rules, regulations and managed care reporting requirements.
P. PCG shall monitor claims and cash flows of Managed Care program to ensure CLIENT receives appropriate benefit from the program and has met documentation needs.
Q. PCG agrees to receive compensation for Contracted Services on a contingency fee basis.
This compensation will be based on payments received by CLIENT under the PEMT Program.
R. If, as a result of an audit by AHCA, a refund is required by CLIENT, PCG agrees to return the portion of the compensation fee that was paid on the amount being refunded and will otherwise not be liable for any other costs, fees, expenses, damages, or amounts.