Managed Services Agreement Contract – AGREEMENT FOR MEDICAL OR DENTAL BILLING SERVICES An agreement entered into on _____________ (date), between _______________________ (name of medical billing company), a corporation organized and existing under the laws of the State of ______________, with its principal office located at _________________________ __________________________________________________________ ( street address. , City, State, Zip Code), referred to as Medical Billing, and _____________ (Medical Group Name), a professional association organized and existing under the laws of the State of ______________, with its principal office located at _________________________________ ________________________________________________ (Street Address, City, County, State, zip code), referred to herein as Customer. WHEREAS, Medical Billing is a health care claims processing and services company and __________________________ (customer name) is a health care provider; AND WHEREAS, Medical Billing provides computerized claims, billing, and collection services to health care providers and submits medical insurance claims on behalf of health care providers to government and commercial companies electronically and on paper, and also provides billing services directly to patients or patient components. health care provider payments not covered by insurance; AND WHEREAS, Customer intends to retain Medical Billing to provide it with such claims and billing services pursuant to this Agreement; WHEREFORE, subject to the mutual agreement contained in this Agreement and other good and valuable considerations, the acceptance and sufficiency of which is acknowledged, the parties agree as follows: 1. Beginning on _____________ (date), Medical Billing will process all Customer medical insurance claims for payment by government and commercial companies either electronically or in paper form. Means and will make available all necessary information to properly process customer claims and submit all such billing and insurance information to the appropriate party (eg daily, weekly, etc.) _______________. Medical Billing will process and submit all customer claims within ______ hours electronically if possible and by paper if necessary. 2. Medical Billing will provide the client with a direct fax number, Tel
Where it may send all such billing and claim information to the Medical Billing Address (the Medical Billing Address). 3. Medical Billing will provide the Customer with a direct mobile phone number that the Customer may use in lieu of its own telephone number in accordance with this Agreement if requested by the Customer, (Phone Number), or at the option of Medical Billing Provider. use. (Medical Billing). 4. Medical Billing will provide Customer with its principal office mailing address at (the Medical Billing Address) for receiving and servicing Customer’s monthly billing and for electronically reporting any changes to Customer information and requirements at the charge it chooses. pursuant to this Agreement. 5. Medical Billing will maintain all client records at its main office, as well as on an email server (or as otherwise required by the client from time to time), for its own use and that of its clients, and will provide records subject to the client’s right to inspection and a copy upon request. 6. Medical Billing will make all customer information available to the client to enable the client to obtain a full understanding of any claim. 7. Medical Billing will, during the term of this Agreement, bill its Client for Medical Services provided to Clients and make available to Client a copy of the Client’s statement on a monthly basis. However, if Medical Billing determines that the medical services requested by the Client have not been completed, then Medical Billing will not pay and the Client will be responsible for any additional charges incurred by the third party provider who provided the requested services. 8. Medical billing requires the client to sign and send a copy of the medical billing to all clients (client’s personal health statement, medical records and medical insurance information) annually to ensure that All client information remains current and accurate. 9. Medical Billing shall be provided only to Clients (, all billing services provided for their benefit by Medical Billing. For the avoidance of doubt, all Medical Billing Information provided is may be disclosed only to Clients’ health care providers. 10. When Medical Billing Services are no longer required by Clients, Medical Billing will (in its sole discretion) decide at any time when this Agreement expire if Medical Billing continues to provide Billing Services to Customer. To make such a decision. Medical Billing will provide Customer with at least 30 days notice of such decision, written notice of basis.
Managed Services Agreement Contract
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