Item C24Revised 3/99
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: August 21, 2002 Division: Management Services
Bulk Item: Yes XX No ❑
Department: Administrative Services
AGENDA ITEM WORDING: Approval of Agreement with MultiPlan, Inc. to provide
nationwide network of healthcare providers. Approval requires waiving RFQ process as
all other RFQ's have only provided networks that have per employee costs whether
network is accessed or not. MultiPlan charges a percent of savings.
ITEM BACKGROUND: On March 21, 2001, the Board of County Commissioners
approved increasing out -of -network disincentive from 10% to 30% and the elimination of
the out -of -network exclusion pending the adoption of a nationwide network.
PREVIOUS RELEVANT BOCC ACTION: Approved March 21, 2001 pending location of
nationwide network.
CONTRACT/AGREEMENT CHANGES: Not applicable
STAFF RECOMMENDATION: Approval.
TOTAL COST: Percentage of Savings BUDGETED: Yes ❑ No ❑
COST TO COUNTY:
REVENUE PRODUCING: Yes ❑ No ❑ AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY ATTY ❑ OMB/PURCHASING ❑ RISK MANAGEMENT ❑
DIVISION DIRECTOR APPROVAL: Q,
DIVISION DIRECTOR NAME: James L. Roberts
DOCUMENTATION: INCLUDED: ❑ TO FOLLOW: ❑ NOT REQUIRED: ❑
DISPOSITION: AGENDA ITEM #:
Administrative Services Contract Review Worksheet
Contract with
��� BOCC Meeting Date
If there is a cost to Monroe County, is funding available? Yes No N/A_ (If no call Department)
Is Cost to Monroe County: /(' �"]�� 1 /
under $5,000_ (r L.� I LG
$5,000-$25,000 — did the department get two written quotes? Yes No (check with department)
over $25,000 was this bid out? Yes No (check with Lisa Cherry
Is this the low bidder? Yes No
c
FS 287.0582 — all contracts which bind ,Vlonroe County for the purchase of services or tangible personal
propertyfor a period in excess of I fiscal year must have the following statement included in the contract.
"Monroe County's performance and obligation to pay under this contract, i .contingent upon an a n aI
appropriation by the BOCC " Is Non Appropriation Clause present? Yes
FS 287.133 — requirement for vendors to file a public entity crime statement prior to issuance of a purchase
order or contract having a value in excess of the threshold for Category two (511, 000 per state 518196).
Statement which reads as follows: `A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a cons act to provide any goods or
services to a public entity, may not submit a bid on a contract with a public entityfor the construction or
repair of a public building or public work, may not submit bids on leases of real property to public entity,
may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a
contract with any public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months fro t
date of being placed on the convicted vendor list. " Is Public Entity Crime Statement present? Yes o
Is Ethics form or statement present? Yes fito 1
(If no comment on contract summary) (- f
If this is a grant agreement, is budget set up? Yes No /A
(If no keep copy with resolution folder)
If this is an amendment, is original contract included? Yes No O/A
(If no make note to department)
Is there a cost of living clause? Yes No / If so does wording match Purchasing Policy Wording
"adjusted annually in accordance with th erc
(CPI-U) for tentage change in the Consumer Price Index for all urban
consumers he most recent 12 months available"? Yes No N/A
Contract read and reviewed by
If cost to Monroe County is over $100,000 ro
Budget Director.
for Administrative Services, otherwise route to
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Multi -Plan, Inc.
Contract #
Effective Date: January 1, 2003
Contract Purpose/Description:
Expiration Date: December 31, 2 003
To enter into an agreement with a Nationwide Network of healthcare providers.
Contract Manager: Maria Fernandez
(Name)
4448 Administrative Services/Stop 1
(Ext.) (Department/Stop #)
for BOCC meeting on August 21,
2002
Agenda Deadline: August 7, 2002
CONTRACT COSTS
Total Dollar Value of Contract: $ Percentage Current Year Portion: $
of savings
Budgeted? Yes❑ No ❑ Account Codes:
Grant: $
County Match: $
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
Not included in dollar value above) (e . maintenance, utilities, janitorial, sa
CONTRACT REVIEW
etc.
Changes Date Out
Date In Needed _
!Division• ,.
•E
• , 2 ,, •
County• ;. '+
Commen/
OMB Form Revised 2/27/01 MCP #2 /��
Page 1 of 2
From: Emilio J. Monte <EMonte@healthspectrum.cc>
To: Sheila Barker <barkers@mail. state.fl.us>
Cc: Rick Legg<richard_legg@acordianational .com>; Lora Denny
<lora_denny@acordianational. com>; Michael E. Monte
<mmonte@health spectrum. cc>
Date: Tuesday, August 06, 2002 9:39 AM
Subject: Fw: Contract
Sheila,
Attached please find your Multiplan Agreement and pricing Addendum. Acordia
National already has a contract with Multiplan and would do the re -pricing
under this agreement. The Acordia National fee is included in the 25% of
savings fee that Multiplan has quoted.
Please call me with any questions.
Thank You,
Emilio J. Monte
HealthSpectrum, Inc.
----- Original Message -----
From: "Victor Dezelic" <VDezelic( )MultiPlan com>
To: <emonte@health spectruM.
Sent: Monday, August 05, 2002 3:29 PM
Subject: Contract
Emilio,
Attached is the contract you requested. Please call with any questions.
Thanks.
Vic
Victor P. Dezelic
Assistant Vice President, National Sales
Multiplan, Inc.
115 Fifth Avenue
7th Floor
New York, NY 10003
Phone (212) 780-2225
(800) 677-1098 ext. 2225
Fax (212) 529-7459
8/6/02
MULTIPLAN, INC.
AGREEMENT FOR CLIENT ACCESS TO
FACILITY AND PRACTITIONER NETWORKS
THIS AGREEMENT, effective January 1, 2003, is entered into by and between MultiPlan,
Inc., 115 Fifth Avenue, New York, New York 10003-1004 ("MPI"), and Monroe County
Board of County Commissioners, C/O Acordia National, ("Client"), with principal offices at
1100 Simonton Street, Key West, FL 33040.
WHEREAS, MPI has created and maintains a network ("MPI Network") of health care
providers ("MPI Providers"), by entering into agreements with acute care and ancillary health
care providers ("MPI Facilities"), and physicians and other health care professionals ("MPI
Practitioners"), to provide health care services to individuals ("Participants") covered by health
services benefits programs ("Benefit Programs"), insured or administered by MPI's Clients, in
exchange for reimbursement at agreed upon rates;
WHEREAS, Client either provides a Benefit Program for its Participants, or provides certain
administrative services to its customers who provide Benefit Programs for their Participants; and,
WHEREAS, on behalf of Client's Participants or customers, Client seeks access to MPI's
Facility and Practitioners Networks;
THEREFORE, in consideration of the foregoing and of the mutual covenants herein, intending
to be legally bound hereby, the parties agree as follows:
A. DEFINITIONS
1. Access Fees The rates payable by Client to MPI for access to the MPI Networks, as set forth
in Exhibit 1, annexed.
2. Clean Claim A completed HCFA 1500 or UB-92, or other standard billing forms providing
the same information.
3. Contract Rates The rates of reimbursement for health care services rendered to Participants as
set forth in MPI's agreement with MPI Providers, whether in the form of a per diem, case or
procedure rate, negotiated rate based on published charges, or fee schedule.
4. Employee "Employee" includes retirees eligible for coverage under Client's Benefit Program.
In the event the Client is a union, all references to "Employee" in this Agreement and its
attachments shall be construed to refer to the union member.
5. Market A geographic region defined by MPI for pricing purposes.
6. Savings The difference between the applicable Contract Rate and the MPI Provider's billed
charges (excluding surcharges and the cost of personal convenience items).
Masters/Sales/CI-Net 2002 - rev'd 2-1-02
B. LIMITATIONS
1. Nothing in this Agreement shall be construed to interfere with a Participant's freedom of
choice to receive medical services from MPI, or non-MPI, Providers.
2. MPI's duties are limited to those specifically set forth herein. MPI does not determine
eligibility or benefit availability for Participants under Client's Benefit Program. MPI does not
exercise any control with respect to Client's Benefit Program policies, practices, procedures, or
assets including payment of claims. MPI has no responsibility for the sale or marketing of
Client's benefit program(s), and MPI has no responsibility for communicating with Participants
or prospective Participants about Client's Benefit Program coverage, including benefits and/or
eligibility criteria or determinations.
3. MPI Providers solely are responsible for the professional advice and treatment rendered to
Participants, and MPI disclaims any liability with respect to such matters.
C. MUTUAL RIGHTS AND OBLIGATIONS OF THE PARTIES
1. Records and Audit Each party shall maintain complete and accurate records in connection
with this Agreement and, subject to confidentiality provisions contained herein, each party shall
have the right, upon ten business days' written notice, during normal business hours and at no
charge, to perform one audit in each contract year of such records of the other party. The
auditing party shall provide the other with a copy of its audit report. The rights set forth in this
provision shall survive the termination of this Agreement for one year.
2. Confidentiality The parties agree to hold all information provided by one party to the other
exchanged in contemplation of, or in connection with duties under this Agreement, confidential
for the term of this Agreement, and for two years thereafter, and shall not disclose such
information to any third party except as required to implement this Agreement, as required by
law or regulation, or with the prior written permission of the other party.
3. Indemnification Each party shall indemnify and hold the other, including its officers,
directors, employees, agents, successors and assigns, harmless from and against all claims,
liability, loss, damages, and expenses, which may be alleged against or incurred by the other
party and which are the result of breach of this Agreement or proximately caused by the
negligent omission or commission of the indemnifying party in connection with any obligation
set forth in this Agreement. Client's indemnification liability and obligation under this Section
C3 is to the extent authorized by Sec. 768.28, F.S.
D. RIGHTS AND OBLIGATIONS OF MPI
1. Network Recruitment MPI's duties are limited to recruiting and contracting with a network
of Providers who have agreed to accept Contract Rates as full reimbursement for covered health
care services rendered to Participants eligible under Client's Benefit Program, and credentialing
practitioners. Whenever possible, MPI will contract directly with providers, however, MPI may
contract with existing local networks.
Masters/Sales/CI-Net 2002 - rev'd 2-1-02 2
2. Directories MPI shall provide Client with a printed directory of MPI Providers and a toll
free telephone number for use by Client and Participants in determining whether a provider is in
the MPI network, and for referrals to MPI Providers. In addition, MPI's directory shall be
available on MPI's Website, www.multiplan.com.
3. Use of Name MPI shall permit Client to list MPI's name and logo, indicating Client's
participation in the MPI Network, in Client's health benefits directory and related written
materials as well as on Client's data base, however, no other use of MPI's name by Client will be
permitted without MPI's prior written approval.
4. Dispute Resolution MPI will make its best efforts to assist Client in resolving disputes
that may arise with MPI Providers in connection with this Agreement.
E. RIGHTS AND OBLIGATIONS OF CLIENT
1. Payment of Access Fees:
a. Amount of Access Fees Client shall pay MPI Access Fee amounts as set forth in
Exhibit 1. Payment to MPI shall be made within twenty days after the end of each month
for the prior month.
b. Manner of PayMent
Client shall charge its customers for the customers' right to access the MPI
Networks according the same method by which Client pays MPI for access,
that is, if Client pays MPI on Capitated basis, Client shall charge its customers
on a Capitated basis, however, if Client pays MPI on a Percentage of Savings
basis, Client shall charge its customers on a Percentage of Savings basis.
ii If Client pays Capitated Access Fees (per Employee per month), payment
shall be accompanied by a signed statement of an officer of Client or
Customer liable for claim payments under the Benefit Program, setting forth
the number of Employees entitled to access the MPI Network during the prior
month. Such statement shall be a complete and accurate representation of the
information stored in Client's or Customer's eligibility system.
C. Electronic Format Client agrees to use its best efforts to accept electronic
invoicing from MPI, and to submit payment information to MPI in the same format.
d. Late Pavment of Access Fees Interest of 1.5% per month shall apply to late
Access Fee payments. In addition, Client shall pay all expenses incurred by MPI in
connection with the collection of such fees, including any attorney's fees, whether or not
suit is filed.
Masters/Sales/O-Net 2002 - rev'd 2-1-02
2. Participant Identification
a. Identification Cards and EOBs Client shall permanently print or otherwise affix
MPI's name and logo on all Participant identification cards as of the effective date of this
Agreement. Client shall print MPI's name and/or logo on Explanation of Benefit notices
sent to MPI Providers regarding claims paid at Contract Rates pursuant to this
Agreement. If Client prints MPI's toll free referral line telephone number on Participant
identification cards, the number shall be printed in at least eight -point type and in bold. If
the number is printed in a smaller type, and/or not in bold, Client shall be liable for any
damages assessed against MultiPlan regarding calls made by, or on behalf of, Participants
which were intended for the referral line but which reached another number.
b. MPI Provider Notification In addition to the foregoing, Client shall require
Participants to present identification cards bearing MPI's name and logo at the time
services are rendered, or Clients shall otherwise notify MPI Providers at the time services
are rendered that Client is entitled to access MPI's rate on behalf of Participant.
Eligibility and Coverage Determinations
i. Client solely shall be responsible for making all determinations regarding
eligibility and benefits coverage in connection with this Agreement.
ii. Client shall verify a Participant's eligibility within twenty-four hours of an
MPI Provider's request for verification. Client shall be bound by its certification
of Participant eligibility given to MPI Providers in writing or by telephone.
iii. Client shall be bound by authorizations for treatment, and/or certification
of coverage of specified services, given to MPI Providers in writing or by
telephone, provided that claims information is consistent with the information on
which the authorization was based.
Repricing
Client shall elect one of the following repricing options upon execution of this
Agreement, by initialing the appropriate selection below:
EDI Repricing MPI and Client shall mutually agree upon method of EDI
transmission by which Client shall send and receive claims data to and from MPI.
Client shall be responsible to maintain its own telephone line(s), internet access, and
to pay its own telephone charges, if applicable. MPI shall transmit repricing
instructions to Client by EDI transmission. MPI reserves the right to charge Client
for customized programming that may be required to establish the EDI connection.
X Web -based Repricing MPI shall provide Client with a password that will
give Client Web -based access to MPI's Contract Rate information for the purposes of
repricing. Client shall be responsible to supply telephone line(s) and to pay telephone
charges.
Masters/Sales/CI-Net 2002 - rev'd 2-1-02
Facsimile Transmission Repricing Client shall send to MPI by facsimile
transmission all claims for services rendered to Participants by MPI Providers. Client
shall pay MPI for Facsimile Transmission Repricing services as set forth in Exhibit 1.
4. Payment to MPI Providers
a. Timeliness Client shall make payment at Contract Rates directly to MPI
Providers for covered services rendered to Participants within thirty (30) business days of
receipt of a Clean Claim.
b. Use of Contract Rates
i. Client and its customers shall use the Contract Rates exclusively for the
purposes set forth herein. Use of the Contract Rates in connection with claims for
services rendered to individuals who are not eligible Participants is prohibited and
shall be considered by MPI to be a material default in Client's obligations
hereunder. In addition, Client and/or its customer(s) shall reimburse affected MPI
Providers the difference between full charges and the inappropriately applied
Contract Rate(s).
ii. In the Market for which Client purchases access to MPI's Facility and
Practitioner Networks, Client shall utilize MPI's Facility and Practitioner
Networks as its sole PPO networks. In compensating MPI Providers for health
care services rendered to Members in connection with this Agreement, Client
shall use only MPI's Contract Rate and may not use any other savings or cost -
containment arrangement that otherwise might be available to Client, for instance
Client shall not apply its own usual, and/or reasonable, and customary criteria.
iii. Co-insurance ratios and deductibles shall be applied against Contract Rates.
iv. Client shall notify MPI within thirty days of receipt of a Clean Claim if Client
decides not to apply a MPI Contract Rate, or Client shall be liable to MPI for the
Access Fee relating to that Clean Claim.
C. Utilization Review In the event Client or its designee performs utilization review,
or case management, Client shall pay MPI Provider eighty percent (80%) of the Contract
Rate within 30 business days of receipt of the claim. Based on the results of the review
Client shall pay MPI Provider any balance due, or notify MPI Provider in writing that a
refund is owed to Client, and MPI Provider shall make the refund within thirty business
days after the notice is received. Client shall not forfeit the Contract Rate if Client
follows this procedure, provided that review is completed and any final payment is made
within sixty (60) days from receipt of the claim, unless Provider contract provides
otherwise.
d. Disputed Claims Client shall notify MPI within sixty (60) days of Client's receipt
of a claim in dispute. Client shall cooperate with MPI in resolving the dispute, and shall
make available to MPI, at no charge, necessary documentation and personnel to facilitate
resolution of the dispute.
Masters/Sales/CI-Net 2002 - rev'd 2-1-02
C. Coordination of Benefits Client shall assist MPI Providers in coordinating
benefits consistent with current industry standards. When Client is the secondary payor,
Client's payment together with the primary payment and any coinsurance shall not exceed
Contract Rates.
5. Distribution of Directories Client shall provide its Participants and/or its customers'
Participants with a directory of MPI Providers based upon camera-ready copy to be supplied by
MPI at no cost, or upon Client's request MPI will provide Client with printed directories for
which Client will pay as set forth in Exhibit 1.
6. Financial Incentives to Participants Client shall provide Participants with financial
incentives to utilize MPI Providers including, but not limited to, passing along to Participants the
full benefit of savings achieved hereunder by calculating coinsurance based on Contract Rates.
Client shall advise MPI of financial incentives made available to Participants, which may include
tiered benefit programs, that include in -and out -of -network benefits, in which covered services
rendered to Participants by MPI Providers shall be deemed in -network services.
7. Third Party Administrators and Reinsurers
a. Construction All obligations of the Client set forth herein with respect to
Participants shall be construed to apply to customers of the TPA or Reinsurer, and the
customers' respective Participants. It is understood that TPA is not liable for the
payment obligations of its customers.
b. Joinder Agreements Client shall cause each current and future customer to
execute a Joinder Agreement, sample annexed as Exhibit 2, which shall be made a part
hereof. Client shall provide to its Customers that have executed Joinder Agreements, a
copy of any executed amendment(s) to this Agreement.
C. Census With respect to each Customer for which Client pays capitated Access
Fees, Client shall submit a completed Census, which shall be annexed hereto as Exhibit
3. Client shall submit an updated Census for each such customer with each monthly
Access Fee payment.
8. Non -Solicitation of MPI Providers Client shall not solicit, nor allow any third party on
its behalf to solicit, any MPI Provider to create a direct relationship with an MPI Provider for the
purpose of providing health care services to Participants during the term of this Agreement and
for a period of one year thereafter.
9. Client Solvency
a. Client represents and warrants that it has sufficient money on hand to pay all
claims that it reasonably anticipates will accrue over the three-month period immediately
following execution of this Agreement and that at any point during the term of this
Agreement it shall have a reserve fund sufficient to pay all claims that it reasonably can
anticipate will accrue during the three-month period which follows.
Masters/Sales/Cl-Net 2002 - rev'd 2-1-02
b. If Client's liability under this Agreement is covered by reinsurance, Client
represents and warrants that the reinsurer periodically audits or certifies Client's ability to
pay claims that are due and, in case of the Client's insolvency, will pay all claims due
under this Agreement as if the reinsurer was the primary obligor.
10. Client's Benefits Plans Client bears all responsibility for the sale and marketing of its
Benefit Plan(s), and for education of its Participants as to the Participants' rights regarding their
care and treatment, as defined by Client's Benefit Plan. Client's sales and marketing activities
shall not intentionally or unintentionally mislead Participants and prospective Participants.
Benefits available under Client's Benefit Program must meet or exceed MPI's Contract Rates.
11. Provision of Data
a. Implementation Upon request and at no charge, Client shall provide MPI, all
information reasonably necessary to implement, operate, and evaluate the services
provided pursuant to this Agreement including, but not limited to, the names and
locations of all subgroups, subsidiaries, or affiliates accessing the MPI Networks or
acting as payor pursuant to this Agreement, and Census information, as described herein.
b. Provision of Benefit Program Documents At the request of either MPI or an MPI
Provider, Client shall provide a current copy of Benefit Program documents (e.g. member
contract or Summary Plan Description), and/or Utilization Review programs.
12. Service Entities In the event that Client retains any person or organization ("Service
Entity") for the purposes of providing Client with any administrative services that would cause
the Service Entity to come into possession of or contact with any of MPI's Confidential or
proprietary information, including but not limited to MPI's Contract Rates, Client shall enter into
a confidentiality agreement with said Service Entity to preserve the confidential and proprietary
nature of MPI's repricing information. MPI shall be named as a third party beneficiary of the
confidentiality agreement. Upon request by MPI, Client shall provide MPI a copy of such
executed confidentiality agreement.
F. TERM AND TERMINATION
1. This Agreement shall commence on the effective date for a term of one (1) year and shall
renew automatically for successive one year terms unless either party provides the other at least
ninety days notice of its desire to terminate this Agreement without cause. Such termination
shall be effective on the first day of the month following the completion of the ninety day notice
period.
2. Client shall be in default if Client fails to provide any data or information required to be
provided under this Agreement, if Client has not made any payment required under this
Agreement, or if Client improperly uses Contract Rate(s) as described in Section E(4)(b)(i).
3. If Client defaults in payment of Access Fees and is in arrears more than sixty (60) days,
or improperly uses a Contract Rate(s) as described in Section E(4)(b)(i), MPI may terminate this
Agreement for cause upon ten days' written notice. This provision shall not apply to Access Fees
related to disputed amounts described in Section E(4)(d).
Masters/Sales/O-Net 2002 - rev'd 2-1-02 7
4. In the event that Client defaults by failing to make payment to MPI Provider(s) as
required in Section E(4), or by failing to provide MPI with data or information required herein,
MPI shall have the right to terminate this Agreement for cause upon thirty days' notice. This
provision shall not apply to disputed amounts described in Section E(4)(d).
5. This Agreement shall terminate automatically in the event either party becomes insolvent,
is adjudicated as a bankrupt, makes a general assignment for the benefit of creditors, has a
receiver appointed for it, or comes under the control of a trustee in bankruptcy.
6. Effect of Termination
a. In addition to any other provision for the survival of obligations otherwise set
forth in this Agreement, the following obligations shall survive termination of this
Agreement, for whatever reason:
i. all obligations of Client regarding payment to MPI and/or to MPI Providers;
ii. all obligations to provide information to MPI;
iii. all obligations of both parties regarding confidentiality;
iv. all audit rights
b. Upon termination, each party promptly shall pay to the other any money due
hereunder, including any interest accrued. Client shall advise Participants of the
termination of this Agreement, and shall withdraw from Participants all
identification cards bearing MPI's name and/or logo. Client also shall
immediately cease to otherwise use MPI's name and logo.
C. Upon termination, MPI shall notify MPI Providers that Client is no longer entitled
to access MPI's network.
d. Client immediately shall cease to use MPI's Contract Rates and Client shall not
attempt to reprice any claim for services rendered by MPI Providers after the date of
termination. Notwithstanding the foregoing, during a ninety day "run -out period" after
the termination, MPI shall reprice claims for services rendered to Participants by MPI
Providers prior to the date of termination, but forwarded to MPI following the effective
date of termination of this Agreement. Client shall reimburse MPI for such repricing
services according to the terms and conditions of this Agreement. If under this
Agreement Client paid Access Fees on a capitated (per Employee per month) basis,
Client shall continue to pay such capitated Access Fees for all Employees during the
ninety day run -out period. Notwithstanding the foregoing, if Client sends and MPI
receives timely notice that a claim for services rendered prior to termination was in
dispute, and the request to reprice the claim is received by MPI within ten business days
of the dispute's resolution, such claim also will be repriced by MPI following termination
of the Agreement.
Masters/Sales/CI-Net 2002 - rev'd 2-1-02 8
G. NOTICE
Any notice required to be given by this Agreement shall be in writing and delivered to the other
party by hand, or by certified mail with return receipt requested, or by facsimile transmission
supplemented by overnight delivery, to the individual and the address printed below.
H. MISCELLANEOUS
1. This Agreement, with its Exhibits and any other attachments, constitutes the entire
agreement between the parties with respect to the subject matter hereof and shall supersede, as of
its effective date, any previous agreements or understandings, written or oral, between the parties
hereto.
2. This Agreement shall not be changed or amended except in writing, signed by both
parties hereto. If any term of this Agreement is held by a court to be unenforceable or
inoperative, the other terms not subject to such holding shall remain enforceable. This
Agreement shall be governed by New York State law.
3. Any unresolved dispute arising under this Agreement shall be submitted to binding
arbitration before the American Arbitration Association ("AAA") in accordance with the AAA's
then current Commercial Arbitration Rules for a single Arbitrator. All hearings shall be held in
New York County. Arbitration proceedings shall be initiated with appropriate notice to the other
party and to AAA in writing within sixty days of the date on which the facts giving rise to the
dispute occurred, or reasonably could have been discovered. The decision or award of the
Arbitrator shall be final, and judgment thereon may be entered in any state or federal court of
competent jurisdiction within the State of New York.
IN WITNESS HEREOF, duly authorized representatives of the parties executed this
Agreement, below.
MultiPlan, Inc.
115 Fifth Avenue
New York, NY 10003-1004
al
Donald Rubin Date
Chairman
Monroe County Board of County Commissioners
1100 Simonton Street
Key West, FL 33040
By:
Signature
Print Name and Title
Date
Masters/Sales/CI-Net 2002 - rev'd 2-1-02 9
A.
EXHIBIT 1
MULTIPLAN INC. AGREEMENT
FOR ACCESS TO FACILITY AND PRACTITIONER NETWORKS
PERCENTAGE OF SAVINGS ACCESS FEES AND ADDITIONAL TERMS
Access Fee Amounts
1. Client shall pay MPI Access Fees of Twenty-five Percent (25%) of Savings for
services rendered to a Participant by MPI Facilities and Practitioners to Participants in the
Markets set forth below.
Markets: National
2. The Access Fee shall be reduced by three percent (3%) of Savings in the event
Client reprices MPI Facility claims.
3. Client shall pay an additional ten percent (10%) of Savings if MPI reprices MPI
Practitioner claims (including laboratory and radiology claims).
4. Upon Client's request, MPI will provide such directories for which Client will pay
the actual cost of printing and shipping.
MultiPlan, Inc.
115 Fifth Avenue
New York, NY 10003-1004
By:
Donald Rubin
Chairman
Monroe County Board of County Commissioners
1100 Simonton Street
Key west, FL 33040
By:
Date Signature
Print Name and Title
Date
Masters\Sales\Ex 1 Fac-Prac Percentage rev'd 4/16/01
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
Date:
STATE OF
COUNTY OF
(signature)
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this day of
19
NOTARY PUBLIC
My commission expires:
OMB - MCP FORM #4
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a
contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any
public entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list."
MultiPlan, Inc.
FULL SERVICE NETWORKS
ItiPlan Full Service
twork offered through WPPN -
illy owned affiliate company
.........................................................................................................................................................................................................
Access to MultiPlan's full service network is available to clients whose benefit programs require
the use of MultiPlan logos on plan identification cards and EOBs, as well as certain benefit differentials.
----------------------------------F'"A.............E'S
...........................................
FACILITIES
PRACTITIONERS...............................................................................................................................................
State Hospital
Ancillary
Primary
Specialist
FACILITIES
PRACTITIONERS
Alabama
59
649
544
1,859
State Hospital
Ancillary
Primary
Specialist
Arizona
57
1,159
4,290
8,393
Mississippi
63
373
969
1,515
Arkansas
38
387
715
1,251
Missouri
82
940
3,318
7,948
California
296
5,032
10,651
17,410
Nevada
15
348
835
1,825
Colorado
22
718
943
2,322
New Jersey
74
2,364
8,804
16,218
Connecticut
26
821
2,138
4,712
New Mexico
25
310
741
1,351
Delaware
5
192
282
398
New York
206
4,093
16,301
33,096
District of Columbia
8
78
609
1,301
Ohio
115
2,327
5,686
10,707
Florida
123
5,500
7,354
17,213
Oklahoma
61
602
521
905
Georgia"
64
1,394
1,200
3,215
Oregon
25
381
443
1,372
Illinois
101
1,896
6,000
9,355
Pennsylvania
161
2,698
6,981
12,749
Indiana'
49
1,018
1,297
2,850
Puerto Rico
43
44
1,938
1,308
Kansas
68
430
1,393
2,752
South Carolina
28
598
1,255
2,027
Kentucky
75
663
2,474
4,653
Tennessee
72
1,303
3,484
6,175
Louisiana
116
1,118
3,458
7,039
Texas
303
4,009
15,812
28,478
Maryland
32
1,178
3,291
6,317
Virginia
39
899
2,884
4,493
Massachusetts
57
1,032
3,019
6,548
Washington
86
894
4,447
12,324
Michigan
102
1,474
5,055
8,864
West Virginia
35
295
971
1,454
Minnesota
42
121
995
1,808
Wisconsin
122
1,920
7,865
18,453
'see Preferred Plan map
Full Service Network Nationwide Totals
Acute Care Hospitals: 2,895 Primary Care Physicians: 138,963 SPRING 2002
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Ancillary Facilities: 49,258 S ecialists: 270 658 677-1098
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Facsimile Transmission Repricing Client shall send to MPI by facsimile
transmission all claims for services rendered to Participants by MPI Providers. Client
shall pay MPI for Facsimile Transmission Repricing services as set forth in Exhibit 1.
4. Payment to MPI Providers
a. Timeliness Client shall make payment at Contract Rates directly to MPI
Providers for covered services rendered to Participants within thirty (30) business days of
receipt of a Clean Claim.
b. Use of Contract Rates
i. Client and its customers shall use the Contract Rates exclusively for the
purposes set forth herein. Use of the Contract Rates in connection with claims for
services rendered to individuals who are not eligible Participants is prohibited and
shall be considered by MPI to be a material default in Client's obligations
hereunder. In addition, Client and/or its customer(s) shall reimburse affected MPI
Providers the difference between full charges and the inappropriately applied
Contract Rate(s).
ii. In the Market for which Client purchases access to MPI's Facility and Practitioner
Networks, Client shall utilize MPI's Facility and Practitioner Networks as its sole PPO networks
outside of South Florida (Monroe, Miami -Dade, Broward and Palm Beach counties)) . In
compensating MPI Providers for health care services rendered to Members in connection with
this Agreement, Client shall use only MPI's Contract Rate and may not use any other savings or
cost -containment arrangement that otherwise might be available to Client, for instance Client
shall not apply its own usual, and/or reasonable, and customary criteria.
iii. Co-insurance ratios and deductibles shall be applied against Contract Rates.
iv. Client shall notify MPI within thirty days of receipt of a Clean Claim if Client
decides not to apply a MPI Contract Rate, or Client shall be liable to MPI for the
Access Fee relating to that Clean Claim.
C. Utilization Review In the event Client or its designee performs utilization review,
or case management, Client shall pay MPI Provider eighty percent (80%) of the Contract
Rate within 30 business days of receipt of the claim. Based on the results of the review
Client shall pay MPI Provider any balance due, or notify MPI Provider in writing that a
refund is owed to Client, and MPI Provider shall make the refund within thirty business
days after the notice is received. Client shall not forfeit the Contract Rate if Client
follows this procedure, provided that review is completed and any final payment is made
within sixty (60) days from receipt of the claim, unless Provider contract provides
otherwise.
d. Disputed Claims Client shall notify MPI within sixty (60) days of Client's receipt
of a claim in dispute. Client shall cooperate with MPI in resolving the dispute, and shall
make available to MPI, at no charge, necessary documentation and personnel to facilitate
resolution of the dispute.
Masters/Sales/Cl-Net 2002 - rev'd 2-1-02 5 ��