INSURANCE VERIFICATION/AUTHORIZATION AGREEMENT
SECTION 1 –TERMS FOR PMD
- PMD agrees to provide CLIENT with the services described herein and at the fee noted in Section 3 of this agreement, and to CLIENT’S specifications per Section 4 of this agreement.
- PMD will take all necessary steps to ensure that the verification data is as accurate as possible, however, the information provided by the health insurance company representative may be misleading or grossly inaccurate. PMD will provide a reference number for the call and the first name and last initial of the representative.
- PMD will charge the Clients credit card prior to performing verification service.
- PMD agrees to keep confidential all information designated as proprietary, provided that information is not generally known or knowable to the general public.
- PMD will provide a secure portal for document exchange which includes patient information and completed authorization/Verification data.
SECTION 2 – TERMS FOR CLIENT
- CLIENT will provide necessary information as accurately as possible.
- CLIENT will be upload all documents required to complete the authorization/Verification process to the secure portal provided by PMD.
- CLIENT accepts that PreferredMD will provide accurate and timely verifications as received from insurance carriers. Verifications data are complete with reference numbers and insurance carrier representative identification. The validity of the data provided to PreferredMD relies solely on the carrier. The benefits information is not a guarantee of payment. Actual claim payment is determined at the time of claim adjudication by insurance carriers.
- CLIENT will reconfirm the insurance benefit of the patient if CLIENT intends to make a determination of financial responsibility for the patient at the time when medical services are rendered.
- CLIENT agrees to payment of PMD fees per Section 3 of this agreement.
- CLIENT agrees to keep all information designated as proprietary as confidential, provided that information is generally not known or knowable to the general public.
SECTION 3 – GENERAL AND FINANCIAL OBLIGATIONS
- CLIENT agrees to pay $ 12.95 (twelve dollars and nintyfive cents) per authorization/verification request in the specialty of surgery.
- If there are any changes to the scope of the verification, CLIENT will inform PMD promptly.
SECTION 4 – SPECIFICATIONS OF VERIFICATION
- CLIENT will submit request with pertinent data as accurately as possible through a secure portal established by PMD.
- PMD will concurrently receive notification that a request by Client has been submitted.
- PMD will access the request through the secure portal.
- PMD Personnel will then call insurances companies gather answers to a specific set of questions that have been agreed upon by both parties.
- CLIENT will be informed that data has been securely uploaded to the secure portal for review.
SECTION 6 – INDEMNIFICATION
6.1 The Client agrees to and shall indemnify and hold harmless PMD, its employees, agents and subcontractors, from and against all claims, debts, liabilities, demands, obligations costs, expenses, actions causes of action and claims for relief including those brought by any third party or by the CLIENT, including reasonable attorneys’ fees and losses, asserted against and alleged to be caused by PMD’s performance, negligence or failure to perform any obligation under this Agreement. The Parties agree that there are no third party beneficiaries of this Agreement.
SECTION 7 – EXCULPATORY CLAUSE
7.1 The CLIENT agrees that PMD is not an insurer and that no insurance coverage is offered herein. The CLIENT agrees that PMD is not assuming liability, and, therefore shall not be liable to the CLIENT for any claims, debts, liabilities, demands, obligations costs, expenses, actions, causes of action and claims for relief as a result of any claim, audit, investigation, litigation or arbitration, or any other cause, whatsoever, regardless of whether or not such loss or damage was caused by or contributed to by PMD’s negligent performance, or failure to perform any obligation. The CLIENT hereby releases PMD from any claims for contribution or indemnity.
SECTION 9 – PMD WARRANTY AND LIMITED WARRANTY OF CLIENT
9.1 PMD Warranty Limited Remedy of the CLIENT: PMD warrants that it shall verify the patients health insurance benefits on behalf of the CLIENT in a good and workmanlike manner. PMD expressly disclaims any and all other warranties whether oral or written, expressed or implied. Without in any way limiting the generality of the foregoing disclaimer or warranties, PMD makes no warranty or representation whatsoever as to when or if any particular insurance claim will be honored/paid by the insurer.
- The CLIENT understands that PMD has no professional licensure certification, and understands that PMD is not a medical practice, and that no member of PMD’s staff is acting in any capacity as a licensed healthcare professional. The CLIENT understands that it is responsible for all aspects of professional services provided by the CLIENT, as well as the determination of all applicable billing codes to be used in bills for any professional medical services rendered. PMD may try to predict, based on its experience and judgment, what might likely evolve, but cannot guarantee what may be obtainable. PMD’s has made no representations, guarantees, assurances or warranties regarding the outcome of any matter. The CLIENT understands that PMD does not represent nor warrant that its Services will prevent any claims, debts, liabilities, demands, obligations, costs, expenses, actions, causes of action and claims for relief arising from the CLIENT’s billing procedures by way of any claim, audit, investigation, litigation or arbitration, or any other cause, whatsoever. In no event shall PMD be liable for damages or breach due to natural disasters, or other matters beyond the reasonable control of PMD.
- The Parties agree that the Fees paid by the CLIENT to PMD are for Services rendered, not for a guaranteed outcome. If, notwithstanding the terms of this Agreement there should arise any liability on the part of PMD as a result of its negligence to any degree or failure to perform any obligation, such liability shall be limited to 3 times the fee charged for a single patient’s verification of benefits.
SECTION 10 – HIPAA
10.1 both parties agree that all applicable policies and procedures are HIPAA compliant and secure. PMD and CLIENT will follow all integrity controls and encryption guidelines set forth by HIPAA regulations.
10.2 PMD agrees that all work on transferred data is done without the data ever leaving the transfer destination. All servers are password protected and are fully secure with firewall protection. All data is password protected on both ends of the transfer, and in storage.
10.3 Any change needed in these protocols will be provided to either party in writing. Both parties will be responsible for maintaining these protocols in their respective servers.
SECTION 11 – MISCELLANEOUS
11.1 This agreement is in effect beginning on the effective date stated herein and shall remain in effect until terminated by either party as provided herein.
11.2 Should either party decide to terminate agreement, a Notice of Termination shall be in writing and shall be received by either party 30 days prior to date of termination. Breach of contract may void said termination notice.
11.3 This Agreement may be amended at any time by mutual written agreement executed by the parties
11.4 Notices, amendments, or other communications provided under this Agreement shall be made in writing to both parties as follows: (electronic transfer is acceptable if agreed by both parties)
227 East 56th st, suite 203
New York, NY 10022
11.5 PMD is an independent contractor and is not an employee, agent, or legal representative of CLIENT. The relationship between the parties will not constitute any form of joint venture, partnership, agent/principal, or other relationship.
11.6 Neither CLIENT nor PMD may assign, delegate or transfer this Agreement or the rights granted herein without written consent of the other party.
11.7 This Agreement contains all the terms and conditions agreed upon by the parties and it super cedes all other Agreements, express or implied, regarding the subject matter.
11.8 This Agreement is binding upon the parties hereto as well as their permitted successors and assigns
11.9 This Agreement shall be interpreted under the laws of the State of New York. CLIENT and PMD are subject to the jurisdiction of the District Court of NEW YORK, State of New York.
11.10 Legal Action: THE PARTIES AGREE THAT DUE TO THE NATURE OF THE SERVICES TO BE PROVIDED BY PREFERRED MD SOLUTIONS THE PAYMENTS TO BE MADE BY THE CLIENT FOR THE TERM OF THIS AGREEMENT FOR BILLING AND COLLECTION SERVICES ARE AN INTEGRAL PART OF PREFERRED MD SOLUTIONS’S ANTICIPATED PROFITS: THAT IN THE EVENT OF THE CLIENT’S DEFAULT IT WOULD BE DIFFICULT TO DETERMINE PREFERRED MD SOLUTIONS’S ACTUAL DAMAGES. THEREFORE, IN THE EVENT OF THE CLIENT’S DEFAULT IN THE PAYMENT OF ANY CHARGES TO BE PAID TO PREFERRED MD SOLUTIONS, THE BALANCE OF ALL ANTICIPATED PAYMENTS OWED TO PREFERRED MD SOLUTIONS FOR THE ENTIRE TERM HEREIN SHALL IMMEDIATELY BECOME DUE AND PAYABLE. IF PREFERRED MD SOLUTIONS PREVAILS IN ANY LITIGATION OR ARBITRATION BETWEEN THE PARTIES, THE CLIENT SHALL BE SOLELY RESPONSIBLE FOR PREFERRED MD SOLUTIONS’S LEGAL FEES. ANY DISPUTE BETWEEN THE PARTIES, INCLUDING ISSUES OF ARBITRABILITY, SHALL, AT THE OPTION OF ANY PARTY, BE DETERMINED BY ARBITRATION ADMINISTERED BY AMERICAN SERVICES, INC. UNDER ITS COMMERCIAL RULES. SERVICE OF PROCESS OR PAPERS IN ANY LEGAL PROCEEDING OR ARBITRATION BETWEEN THE PARTIES SHALL BE MADE BY FIRST-CLASS MAIL DELIVERED BY THE U.S. POSTAL SERVICE ADDRESSED TO THE PARTY’S ADDRESS IN THIS AGREEMENT OR ANOTHER ADDRESS PROVIDED BY THE PARTY IN WRITING TO THE PARTY MAKING SERVICE. THE PARTIES AGREE TO SUBMIT TO THE JURISDICTION AND LAWS OF THE STATE WHERE PREFERRED MD SOLUTIONS’S PRINCIPAL PLACE OF BUSINESS IS LOCATED AND AGREE THAT ANY LITIGATION OR ARBITRATION BETWEEN THE PARTIES MUST BE COMMENCED AND MAINTAINED IN THE COUNTY WHERE PREFERRED MD SOLUTIONS’S PRINCIPAL PLACE OF BUSINESS IS LOCATED. THE PARTIES WAIVE TRIAL BY JURY IN ANY ACTION BETWEEN THEM. ANY ACTION BY THE CLIENT AGAINST PREFERRED MD SOLUTIONS MUST BE COMMENCED WITHIN ONE YEAR OF THE ACCRUAL OF THE CAUSE OF ACTION OR SHALL BE BARRED. ALL ACTIONS OR PROCEEDINGS AGAINST PREFERRED MD SOLUTIONS MUST BE BASED ON THE PROVISIONS OF THIS AGREEMENT. ANY OTHER ACTION THAT THE CLIENT MAY HAVE OR BRING AGAINST PREFERRED MD SOLUTIONS IN RESPECT TO OTHER SERVICES RENDERED IN CONNECTION WITH THIS AGREEMENT SHALL BE DEEMED TO HAVE MERGED IN AND BE RESTRICTED TO THE TERMS AND CONDITIONS OF THIS AGREEMENT.