Document:

Exhibit 10.53

 

MANAGEMENT SERVICES AGREEMENT

 

BETWEEN

 

PRO MED HEALTH CARE ADMINISTRATORS

 

AND

 

POMONA VALLEY MEDICAL GROUP, INC.,

D.B.A. PRO MED HEALTH NETWORK

 

EFFECTIVE:  OCTOBER
1, 1998

 

 

MANAGEMENT SERVICES
AGREEMENT

 

TABLE OF CONTENTS

 

	
   

  	
   

  	
   

  	
   

  	
  PAGE

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1.

  	
   

  	
  Services
  to be Performed and Manner of Performance

  	
   

  	
  1

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2.

  	
   

  	
  Facilities
  and Personnel

  	
   

  	
  1

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3.

  	
   

  	
  Fees

  	
   

  	
  1

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4.

  	
   

  	
  Payor

  	
   

  	
  2

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5.

  	
   

  	
  IPA’s Plan
  Account and Payment of Revenues

  	
   

  	
  2

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  6.

  	
   

  	
  Term

  	
   

  	
  2

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  7.

  	
   

  	
  Termination

  	
   

  	
  2

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  8.

  	
   

  	
  Liabilities
  and Obligations

  	
   

  	
  3

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  9.

  	
   

  	
  Indemnification

  	
   

  	
  4

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  10.

  	
   

  	
  Accounting
  Records

  	
   

  	
  4

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  11.

  	
   

  	
  Professional
  Services

  	
   

  	
  4

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  12.

  	
   

  	
  Additional
  Services

  	
   

  	
  4

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  13.

  	
   

  	
  Books and
  Records

  	
   

  	
  4

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  14.

  	
   

  	
  Independent
  Contractor

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  15.

  	
   

  	
  Assignments

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  16.

  	
   

  	
  Entire
  Agreement: Amendments

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  17.

  	
   

  	
  Compliance
  with State and Federal Law

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  18.

  	
   

  	
  Force
  Majeure

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  19.

  	
   

  	
  Enforcement
  Overpayment

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  20.

  	
   

  	
  Expenses

  	
   

  	
  5

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  21.

  	
   

  	
  Arbitration

  	
   

  	
  6

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  22.

  	
   

  	
  Confidentiality

  	
   

  	
  6

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  23.

  	
   

  	
  Notices

  	
   

  	
  6

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  SIGNATURES

  	
   

  	
  6

  
	
  FEES AND
  SERVICES EXHIBITS

  	
   

  	
   

  
	
   

  	
   

  	
  EXHIBIT I

  	
  Fees

  	
   

  	
  8

  
	
   

  	
   

  	
  EXHIBIT II

  	
  Services

  	
   

  	
  9

  
	
   

  	
   

  	
  EXHIBITIII

  	
  Compensation

  	
   

  	
  11

  

 

 

MANAGEMENT SERVICES AGREEMENT

 

THIS MANAGEMENT SERVICES AGREEMENT (hereinafter referred to as “Agreement”)
is made and entered into as of the FIRST day of October, 1998, by and between
PRO MED HEALTH CARE ADMINISTRATORS, INC. a California corporation (hereinafter
referred to as “ProMed HCA”) and POMONA VALLEY MEDICAL GROUP, INC., D.B.A. PRO
MED HEALTH NETWORK, a California professional corporation (hereinafter referred
to as “IPA”).

 

RECITALS

 

WHEREAS, ProMed HCA is a company that provides management services to
Independent Practice Associations (IPAs) and other medical organizations, and

 

WHEREAS, IPA is a physician organization organized as a California
professional medical corporation, which has entered into written service
agreements with managed care or health maintenance organizations (HMOs),
licensed pursuant to the California Knox-Keene Act of 1975, and has as its
primary objective to deliver or arrange for the delivery of health care
services to the HMO’s Enrollees, through the IPA’s arrangements or contracts
with health professionals, all of whom are licensed, certified, or otherwise
lawfully qualified to practice their professions in the State of California,
and

 

WHEREAS, IPA desires to have ProMed HCA provide management services and
ProMed HCA is willing to provide such services, under the terms and conditions
set forth in this Agreement.

 

NOW, THEREFORE, in consideration of the mutual covenants and conditions
hereinafter set forth and in exchange for good and valuable consideration, the
receipt and sufficiency of which are hereby acknowledged, the parties agree as
follows:

 

1.             Services to be Performed and Manner of Performance.  ProMed
HCA shall perform the services set forth in the “Fees and Services Exhibits,” Exhibit II,
which is an essential part of this Agreement. 
The services required to be performed by ProMed HCA shall be limited to
the services set forth in the “Fees and Services Exhibits”, Exhibit II.  ProMed HCA shall perform said services
consistently with the terms and conditions of the contracts between IPA and its
contracting Payors and within the framework of the policies, interpretations,
rules, practices and procedures made or established by IPA, provided that such
terms and conditions are made known to ProMed HCA and are consistent and
compatible with the description of services set forth in the “Fees and Services
Exhibits”, Exhibit II, and with all applicable state and federal laws and
regulations.

 

2.             Facilities and Personnel.  ProMed
HCA shall maintain the facilities and personnel necessary to provide the
services to be performed by it under this Agreement.

 

3.             Fees.  IPA agrees to
pay to ProMed HCA for the services provided under this Agreement the fees set
forth on the “Fees and Services Exhibits”, Exhibit I, which is an
essential part of this Agreement.

 

1

 

4.             Payor.  Payor shall be
defined as the managed care or health maintenance organization (HMO),
government agency, employer or other organization which has entered into an
agreement with IPA under which IPA provides medical services to employees,
members or Enrollees (“Enrollees”) based on payments made by the Payor, subject
to the benefits, copayments, limitations and exclusions set forth in the
agreement between the Payor and Enrollees. 
Payor may also mean any other payment source including but not limited
to, Enrollees, coordination of benefits carriers, reinsurance and stop loss
carriers, institutional providers, ancillary providers and third party
liability payors.

 

5.             IPA’s Plan Account and Payment of Revenues.  The
contract between IPA and its contracting Payor shall establish a set of
benefits and other provisions which, for the purposes of this Agreement will be
referred to as a “Plan”.  ProMed HCA
shall establish a Plan Account to be used to pay all Expenses arising under the
Plan as defined in Exhibit III, attached hereto.  Payments made from Plan Account will be in
the amount of Cost of Services and Other Liabilities as defined in Section 20,
currently paid by ProMed HCA, any Additional Services provided per Section 12,
plus fees agreed upon in the “Fees and Services Exhibits”, Exhibit I.  To assure the adequacy of funds to pay all
Expenses under such accounts, IPA agrees to pay to ProMed HCA all of IPA’s
revenues under all Payor agreements and all revenue paid to IPA by any other
Payor as defined in Section 4 above. 
Such payment of revenue is intended to comply fully with relevant state
and federal law.  ProMed HCA shall accept
perpetual and unilateral control over the assets of IPA and will assume risk
for IPA revenue control.  ProMed HCA will
administer all revenues paid by IPA according to the provisions of Section 20.  Expenses and Exhibit III, Compensation,
an essential part of this Agreement.

 

6.             Term.  The term of
this Agreement shall be for a period of twenty (20) years, commencing October I,
1998 and ending September 30, 2018, and shall be automatically renewed for
successive five (5) year periods, unless terminated as hereinafter
provided.

 

7.             Termination.

 

A.          Without Cause:  After the first anniversary date of this
Agreement, either party shall have the right to terminate this Agreement
without cause, effective on any subsequent anniversary date, by giving the
other party advance written notice at least one hundred twenty (120) days prior
to the anniversary date.

 

B.           With Cause:  ProMed HCA may terminate this Agreement
immediately upon delivery of written notice if:

 

1.            IPA is unable to lawfully operate
under its articles of incorporation and bylaws, or

 

2.            IPA or a substantial number of its
member physicians are unable to secure and maintain the required professional
liability insurance, or

 

3.            In the event of a commission of a
material fraudulent act by IPA.

 

2

 

C.          Either patty may terminate this
Agreement for cause by providing thirty (30) days written notice to the other
party specifying material breach of the provisions of this Agreement.  The remedy of such breach will result in the
uninterrupted continuance of the Agreement within the remaining term, provided
that such remedy occurs within twenty (20) days of the receipt of such notice,
or if the breach is failure by IPA to make payments required under this
Agreement, then within ten (10) days of the receipt of such notice.  Circumstances beyond the control of either
party, such as acts of God, shall not be construed as constituting material
breach of this Agreement.

 

D.          The Parties agree that significant
time and effort has been spent by ProMed HCA in the development of managed care
agreements and in the maintenance of said managed care agreements.  IPA also understands and agrees this is an
on-going, time consuming process, and that in the event of termination of this
Agreement:

 

1.            By IPA without cause, IPA shall pay
to ProMed HCA, or;

 

2.            By ProMed HCA for cause, IPA agrees
to pay to ProMed HCA:

 

An amount equal to one hundred (100%) percent of the
IPA’s Total Gross Revenue collected in the twelve (12) months prior to the
termination date

 

“Total Gross Revenue” is defined as the total amounts actually received
from all Payors on a capitated per member per month basis prior to any
deductions, plus the total amounts actually received from all other payment
sources for any payments, reimbursements, compensation and incentive payments
due IPA.  For
the purposes of this Agreement, risk sharing funds are included in the
definition of Total Gross Revenue.

 

E.           If IPA
terminates this Agreement without cause or if ProMed HCA terminates this
Agreement with cause, IPA shall be responsible to continue payment of ProMed
HCA Management Fee in effect at the time of termination, for a period of one (1) year
following termination of Agreement.  The
above-referenced payments in case of termination of this Agreement, stated in
section D above, shall not apply if IPA terminates this Agreement due to the
sale of all or substantially all of the stock or assets of IPA to another
entity which also holds a Management Services Agreement with ProMed HCA.

 

F.           Upon termination of this Agreement,
ProMed HCA shall not be responsible for claims adjudication or issuing of
claims payments for any claims received on and/or after the date of termination.  In the event the parties desire to have
ProMed HCA continue processing claims, such services will be engaged in and
rendered only pursuant to a separate written agreement.

 

8.             Liabilities and Obligations.  ProMed
HCA shall have no responsibility, risk, liability or obligation for the funding
of the Plan or for any extended liabilities for the Plan whether resulting from
the termination of the Plan or from a change to fully or partially insured
funding methods.  Such responsibility,
risk, liability or obligation shall reside solely with IPA, IPA’s contracting
Payor and such other entities as are designated in the Plan.

 

3

 

9.            Indemnification.  ProMed HCA shall indemnify and
hold harmless IPA against any loss, claim or judgment, including reasonable
attorneys’ fees, resulting from the negligent acts or omissions or willful
misconduct of ProMed HCA.

 

IPA agrees to indemnify and hold harmless ProMed HCA against any
expenses, loss, claim or judgment, including reasonable attorneys’ fees,
arising out of or resulting from negligent acts or omissions or willful
misconduct of IPA.

 

In addition, IPA shall indemnify and hold harmless ProMed HCA for
losses, claims or judgments arising out of ProMed HCA’s performance of its
services hereunder where ProMed HCA has substantially adhered to the framework
of policies and procedures made or established by IPA and made known to ProMed
HCA and has otherwise performed its services without gross negligence or
willful misconduct and in accordance with industry practices.

 

10.          Accounting Records.  If requested
by IPA, ProMed HCA shall prepare and maintain records of the accounting of the
Plan funds based upon information provided to ProMed HCA for this purpose by
IPA.  ProMed HCA shall make such records
available within forty-five (45) days of the end of the calendar month in
question.  Said records are defined in
the “Fees and Services Exhibit”, Exhibit II, Sections 2 and 5.

 

11.          Professional Services.  Except as
otherwise specifically provided in any services exhibit attached hereto, ProMed
HCA shall not be required to provide any legal or other professional services
to IPA nor shall ProMed HCA be responsible for providing the services of an
independent accountant, actuary or auditor.

 

12.          Additional Services.  Without the
prior written approval from ProMed I-ICA, IPA shall make changes in the Plan
effective only on the anniversary dates of the documents governing the Plan,
unless otherwise required by applicable law or regulation.  In the event such changes require additional
services to be performed by ProMed HCA, the cost of such services shall be
borne by IPA and upon approval by IPA, such costs will be deducted by ProMed
HCA from Plan Account.

 

13.          Books and Records.  ProMed HCA shall maintain all
records pertaining to the services to be performed by it hereunder.  ProMed HCA shall disclose the information of
such records only to IPA or as designated in writing by IPA to IPA’s designee
or to a person who has obtained an order of a court of competent jurisdiction
requiring such disclosure.

 

Upon termination of this Agreement, ProMed HCA shall deliver to IPA,
upon written request within a time period mutually agreeable, but in no event
greater than six (6) months from the date of termination, information on
all claim histories for the two (2) years immediately preceding the
termination of this Agreement if ProMed HCA has provided administrative
services under this Agreement and/or all files and documents pertaining to
consulting services if ProMed HCA has provided consulting services under this
Agreement.

 

If such information or claim histories is so requested, the IPA agrees
to pay all costs incurred by ProMed HCA in providing such information and
records, including but not limited to, the costs of programming computer
changes and mailing.  If additional 

 

4

 

information is requested
by IPA subsequent to the termination of this Agreement, ProMed HCA shall take
reasonable steps to provide such information and IPA agrees to pay all costs
incurred by ProMed H CA in providing such information, including but not
limited to, the costs of programming computer changes and mailing.  ProMed HCA shall be entitled to retain copies
of all such records at its own expense.

 

14.          Independent Contractor.  It is
understood and agreed by the parties hereto that ProMed HCA is engaged to
perform under this Agreement as an independent contractor and there is no employee-employer
relationship between the parties, nor is there any intent to form any
attachment or affiliation between the parties as a result of this Agreement not
specified in this Agreement.

 

15.          Assignments.  Neither party shall assign nor delegate to any
other person or entity the duties, obligations or responsibilities imposed upon
it by this Agreement without the prior written approval of the other party,
except that ProMed HCA may assign such duties, obligations and responsibilities
to a parent or subsidiary or successor of ProMed HCA upon thirty (30) days
written notice to IPA.

 

16.          Entire Agreement:  Amendments.  This
Agreement including the exhibits hereto and any amendment hereto, contains the
entire agreement between the parties, and all prior proposals, discussions and
writings by and between the parties and related to the subject matter hereof
are superseded hereby.  This Agreement
may be modified or amended only  pursuant
to a written instrument executed by both parties hereto, except that the
parties agree to be bound by applicable provisions mandated by state and
federal law that are proposed in good faith by either party as amendments to
this Agreement.

 

17.          Compliance with State and Federal Law.  If any
provision of this Agreement or any portion thereof is declared invalid or
unenforceable, the remaining provisions shall nevertheless remain in full force
and effect.  This Agreement shall be
interpreted under the laws of the State of California.  IPA shall cooperate in all audits,
applications, licensure, and compliance matters necessary for ProMed HCA to
comply with State and federal law, and with the requirements of industry
accreditation bodies.

 

18.          Force Majeure.  Notwithstanding any provision
of this Agreement to the contrary, neither ProMed HCA nor IPA shall have any
liability to the other for a failure of performance resulting from any cause
beyond its control.

 

19.          Enforcement Overpayment.  ProMed HCA
shall have neither the responsibility nor the obligation to take any action,
legal or otherwise, against IPA or any participant in the Plan or other person
to enforce the provisions of the Plan.  In
the event that IPA desires to engage the services of ProMed HCA for such
purposes, such services may be engaged in and rendered only pursuant to a
separate written agreement between the patties.

 

20.          Expenses.  Following the calculation of the “Management
Fees” in accordance with the Fees and Services Exhibits for any month, but
prior to the payment thereof, ProMed HCA shall be entitled to pay all other
costs, expenses and liabilities of IPA (including, without limitation, all
other costs, expenses and liabilities incurred in defending 

 

5

 

or settling any actions
or procedures, indemnification obligations to any party including ProMed HCA,
and all other liabilities under contracts or otherwise) but excluding all
costs, expenses and liabilities that are the responsibility of ProMed HCA under
this Agreement (collectively, “Other Liabilities”) by reducing the amount
actually paid by ProMed HCA for costs of provider services or health care
services (“Cost of Health Care Services”); provided however that in no event
shall any such reduction in the actual amount of Cost of Health Care Services
paid by ProMed RCA in any month because of the payment of any Other Liabilities
result in a recalculation of the Management Fee for that month.

 

21.          Arbitration.  Any dispute arising under this Agreement that
cannot be settled by the parties may be referred by either party for binding
Arbitration under the commercial rules of the American Arbitration
Association, in Los Angeles County, California, and the judgment of such
arbitration may be entered in any court of competent jurisdiction.

 

22.          Confidentiality.  The parties agree that the
information processes and the work performed under this Agreement is of a
confidential nature.  ProMed RCA shall
provide and IPA shall acknowledge receipt and acceptance of ProMed HCA’s
policies and procedures regarding maintenance of Confidentiality of information.  ProMed RCA shall receive ninety (90) days
notice from IPA prior to implementation of any request by IPA for the revision
or addition of systems and/or procedures under this paragraph.

 

23.          Notices.  Any notice required to be given pursuant to
the terms of this Agreement shall be in writing and shall be hand delivered or
sent, postage prepaid, by certified or registered mail, return receipt
requested, to ProMed HCA or IPA at the addresses set forth below in the
signature section.  The notice shall be
effective on the date delivered by hand or the date of delivery indicated on
the return receipt.

 

IN WITNESS WHEREOF, the parties have signed this Agreement effective
the date first written above.

 

	
  FOR:

  	
  PRO MED HCA 

  	
   

  	
  FOR:

  	
  IPA 

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  By: 

  	
   

  	
   

  	
  By: 

  	
   

  
	
   

  	
  Yvonne K. Sonnenberg, M.H.A. 

  Executive Director

  	
   

  	
   

  	
  Jeereddi A. Prasad, M.D. 

  President

  
	
   

  	
   

  	
   

  	
   

  	
   

  	 

	
  Dated: 

  	
   

  	
   

  	
  Dated: 

  	
   

  	 

	
   

  	
  ProMed Health Care Administrators 

  160 E. Artesia St., Suite 350 

  Pomona, CA 91767 

  909.620.5252

  	
   

  	
   

  	
  Pomona Valley Medical Group, Inc., 

  d.b.a. ProMed Health Network 

  160 E. Artesia St., Suite 350 

  Pomona, CA 91767 

  909.620.5252 

  Tax ID# 95-4142044

  

 

6

 

THIS AGREEMENT IS SUBJECT TO THE FEES AND SERVICES
EXHIBITS

ATTACHED HERETO AND MADE A PART HEREOF.

 

7

 

FEES AND SERVICES EXHIBITS

 

EXHIBIT I - FEES

 

Fees

 

	
  1.

  	
   

  	
  Management Fees: ProMed HCA shall calculate IPA Management Fees on
  a monthly basis, for services provided under this Agreement Management Fees
  shall be an amount equal to the actual cost of administrative and management
  services, plus five (5%) percent of Total Gross Revenue, as defined in
  Section 7.D.2., and shall be calculated prior to the payment of Other
  Liabilities and Cost of Services of IPA. ProMed HCA’s costs shall be defined
  as the amount of all actual costs incurred by ProMed HCA for administration
  and management services provided to IPA during the specific period of this
  Agreement, Plus;

  
	
   

  	
   

  	
   

  
	
  2.

  	
   

  	
  Consulting Fees: When performed by an employee or affiliate of
  ProMed HCA, IPA shall pay ProMed HCA for consultation services (including
  travel expenses) not included in the services described in Exhibit II,
  on a “Per Project” or hourly rate of $150.00 per hour. Charges will be due
  and payable by IPA upon receipt of an itemized statement from ProMed HCA, Plus;

  
	
   

  	
   

  	
   

  
	
  3.

  	
   

  	
  Other Fees: Additional fees for provision of hardware and
  software, not included in initial installation, will be quoted on a “Per
  Project” bases and agreed upon in writing between the parties prior to
  provision of said services. Charges will be due and payable by IPA upon
  receipt of an itemized statement from ProMed HCA.

  
	
   

  	
   

  	
   

  
	
  4.

  	
   

  	
  Timing and Manner of Payment: ProMed HCA shall deduct the Fees from
  IPA’s Plan Account on or before the twentieth (20th) day of each month with
  respect to services provided in the prior month.

  

 

8

 

FEES AND SERVICES EXHIBITS

 

EXHIBIT II - SERVICES

 

Services to be
performed by ProMed HCA

 

	
  1.

  	
  Claims

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Adjudication of claims for IPA’s services.

  
	
   

  	
  b.

  	
  Upon written request by IPA, nonclinical assistance to reconcile
  problems between provider and patients,

  
	
   

  	
  c.

  	
  Match claims to authorizations.

  
	
   

  	
  d.

  	
  Print, sign and transmit medical service payment checks to
  Participating Providers.

  
	
   

  	
  e.

  	
  Microfilm original claims.

  
	
   

  	
   

  	
   

  
	
  2.

  	
  Claims Reports

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Prepare encounter data reports.

  
	
   

  	
  b.

  	
  Prepare accounts receivable reports,

  
	
   

  	
  c.

  	
  Prepare accounts payable reports (if applicable).

  
	
   

  	
  d.

  	
  Prepare month-end claims financial report as appropriate (i.e., lags
  and IBNR).

  
	
   

  	
  e.

  	
  Provide claims utilization/encounter data reports to meet Payor
  requirements.

  
	
   

  	
   

  	
   

  
	
  3.

  	
  Claims Support
  Activities

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Maintain vendor file (provider contract terms and IRS Form 1099
  tax information).

  
	
   

  	
  b.

  	
  Coordinate claims payment policy with IPA.

  
	
   

  	
  e.

  	
  Manage cash balances for claims demand deposit account.

  
	
   

  	
  d.

  	
  Order and implement customized software applications requested by
  IPA, at IPA’s expense.

  
	
   

  	
   

  	
   

  
	
  4.

  	
  Eligibility

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Maintain and update eligibility records on a monthly basis.

  
	
   

  	
  b.

  	
  Provide physician assignment and eligibility and retroactive detail
  reports, which coincide with payments to IPA physicians, on a monthly basis.

  
	
   

  	
  c.

  	
  Prepare capitation payments per IPA guidelines to correspond with
  Payor eligibility and physician assignment.

  
	
   

  	
  d.

  	
  Provide necessary eligibility verification consistent with that
  received from Payor.

  
	
   

  	
   

  	
   

  
	
  5.

  	
  Accounting

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Provide information necessary for IPA’s accountant, to close medical
  expense journals and ledgers each month.

  
	
   

  	
  b.

  	
  Bind and store computerized accounting reports, or microfiche
  reports.

  
	
   

  	
  c.

  	
  Provide incentive distribution payments to IPA Physicians, at IPA’s
  direction.

  

 

9

 

	
  6.

  	
  Authorizations

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Provide on-line authorization services.

  
	
   

  	
  b.

  	
  Provide authorization tracking and verification per IPA policy.

  
	
   

  	
  c.

  	
  Assist in development of guidelines for authorization (i.e. second
  opinion, ancillary services, etc.).

  
	
   

  	
  d.

  	
  Provide trending comparison based on utilization of Primary and
  Specialty Physicians.

  
	
   

  	
  e.

  	
  Generation and distribution of authorization logs to provide
  notification to providers of authorization status, including Initial
  Determination for Medicare line of business.

  
	
   

  	
  f.

  	
  Provide telephone authorization services during working hours and
  nurses by telephone for authorization services after working hours.

  
	
   

  	
   

  	
   

  
	
  7.

  	
  Quality Assurance and
  Utilization Review

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Provide supplemental nursing support services and triage services
  relative to Utilization Review and Quality Assurance.

  
	
   

  	
  b.

  	
  Provide Monthly/Quarterly/Annual Quality Management reports.

  
	
   

  	
  c.

  	
  Provide Daily/Weekly/Monthly Utilization Review reports for IPA’s
  Director/Board.

  
	
   

  	
  d.

  	
  Assist Physicians and make Quality Assurance recommendations in
  Quality Assurance Review.

  
	
   

  	
  e.

  	
  Administer grievance procedures, per Plan requirements.

  
	
   

  	
   

  	
   

  
	
  8.

  	
  Credentials/Contracts

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Assist IPA in development and implementation of credential
  guidelines.

  
	
   

  	
  b.

  	
  Maintain credential and contract files for IPA Physicians.

  
	
   

  	
  c.

  	
  Provide appropriate credential information to contract entities.

  
	
   

  	
  d.

  	
  Assist in marketing IPA to Payors, negotiate and manage contracts.

  
	
   

  	
  e.

  	
  Assist IPA in arranging and negotiating IPA contracts which include,
  but are not limited to: hospitals, home care, radiology, laboratory and other
  ancillary services.

  
	
   

  	
   

  	
   

  
	
  9.

  	
  Administer all revenues
  paid by IPA to ProMed HCA according to the provisions of Section 20,
  Expenses and Exhibit and Exhibit III, Compensation

  

 

10

 

COMPENSATION

 

EXHIBIT III

 

ProMed HCA shall receive one hundred (100%) percent of all IPA
Collections(1)’ for and on behalf of IPA. 
ProMed HCA shall thereafter remit to IPA or its designee(s), a) the full
cost of reimbursing IPA and IPA participating health care providers for those
health care services provided to Payor’s Enrollees by IPA and IPA participating
health care providers using compensation guidelines developed by IPA in
consultation with and approved by ProMed HCA, and b) the full cost of any other
goods, services or benefits provided by IPA to Payor’s Enrollees or
participating health care providers (e.g., malpractice insurance) using
compensation guidelines developed by IPA in consultation with and approved by
ProMed I-ICA.

 

ProMed HCA’s payment hereunder shall be commensurate with the
percentage of IPA Collections which reflects the fair market value of those
administrative services provided by ProMed HCA hereunder.  The percentage as set forth in the “Fees and Services
Exhibits”, Exhibit I may be adjusted by ProMed HCA in response to
fluctuations in market value.  Notwithstanding
anything to the contrary in this Agreement, IPA shall be under no obligation to
pay ProMed HCA any monies in the event those remittances made to IPA as set
forth above are in excess of IPA Collections.

 

(1) IPA Collections
shall mean, for purposes of this Agreement, any and all revenue paid to ProMed
HCA, for and on behalf of IPA, by Payors, Enrollees, coordination of benefit
carriers, reinsurance carriers, institutional providers, ancillary providers
and any other payment source.

 

11Exhibit 10.54

 

MANAGEMENT SERVICES AGREEMENT

 

BETWEEN

 

PRO MED HEALTH CARE ADMINISTRATORS

 

AND

 

UPLAND MEDICAL GROUP, A PROFESSIONAL MEDICAL
CORPORATION

 

EFFECTIVE: OCTOBER 1, 2002

 

1154
N. Mountain Avenue, Upland, California 91786-3633            Phone: 909.932.1045   800.28l-8886   Fax: 909.932-1065

 

 

MANAGEMENT SERVICES AGREEMENT

 

	
  TABLE
  OF CONTENTS

  	
   

  	
  PAGE

  
	
   

  	
   

  	
   

  
	
  RECITALS 

  	
   

  	
  1

  
	
  1.

  	
   

  	
  Services
  to be Performed and Manner of Performance

  	
   

  	
  1

  
	
  2.

  	
   

  	
  Facilities
  and Personnel

  	
   

  	
  1

  
	
  3.

  	
   

  	
  Fees

  	
   

  	
  1

  
	
  4.

  	
   

  	
  Payer

  	
   

  	
  1

  
	
  5.

  	
   

  	
  IPA’s
  Plan Account

  	
   

  	
  2

  
	
  6.

  	
   

  	
  Term

  	
   

  	
  2

  
	
  7.

  	
   

  	
  Termination

  	
   

  	
  2

  
	
  8.

  	
   

  	
  Liabilities
  and Obligations

  	
   

  	
  3

  
	
  9.

  	
   

  	
  Indemnification

  	
   

  	
  3

  
	
  10.

  	
   

  	
  Accounting
  Records

  	
   

  	
  3

  
	
  11.

  	
   

  	
  Professional
  Services

  	
   

  	
  3

  
	
  12.

  	
   

  	
  Additional
  Services

  	
   

  	
  3

  
	
  13.

  	
   

  	
  Books
  and Records

  	
   

  	
  3

  
	
  14.

  	
   

  	
  Independent
  Contractor

  	
   

  	
  4

  
	
  15

  	
   

  	
  Assignments

  	
   

  	
  4

  
	
  16.

  	
   

  	
  Entire
  Agreement; Amendments 

  	
   

  	
  4

  
	
  17.

  	
   

  	
  Compliance
  with State and Federal Laws

  	
   

  	
  4

  
	
  18.

  	
   

  	
  Force
  Majeure

  	
   

  	
  4

  
	
  19.

  	
   

  	
  Enforcement
  Overpayment

  	
   

  	
  4

  
	
  20.

  	
   

  	
  Expenses

  	
   

  	
  4

  
	
  21.

  	
   

  	
  Arbitration

  	
   

  	
  5

  
	
  22.

  	
   

  	
  Confidentiality

  	
   

  	
  5

  
	
  23.

  	
   

  	
  Notices

  	
   

  	
  5

  
	
  SIGNATURES
  

  	
   

  	
  5

  
	
  FEES
  AND SERVICES EXHIBITS

  	
   

  	
   

  
	
   

  	
   

  	
  EXHIBIT
  I - Fees

  	
   

  	
  6

  
	
   

  	
   

  	
  EXHIBIT
  II - Services

  	
   

  	
  7

  

 

 

MANAGEMENT SERVICES AGREEMENT

 

THIS
MANAGEMENT SERVICES AGREEMENT (hereinafter referred to as “Agreement”) is made
and entered into as of the FIRST day of October, 2002, by and between PRO MED
HEALTH CARE ADMINISTRATORS, INC., a California corporation (hereinafter
referred to as “ProMed HCA”) and UPLAND MEDICAL GROUP, A PROFESSIONAL MEDICAL
CORPORATION (hereinafter referred to as “IPA”).

 

RECITALS

 

WHEREAS,
ProMed HCA is a company that provides management services to Independent
Practice Associations (“IPAs”) and other medical organizations, and

 

WHEREAS,
IPA is a physician organization organized as a California professional medical
corporation which has entered into written service agreements with managed care
or health maintenance organizations (“HMOs”), licensed pursuant to the
California Knox-Keene Act of 1975, and has as its primary objective to deliver
or arrange for the delivery of health care services to the HMO’s Enrollees,
through the IPA’s arrangements or contracts with health professionals, all of
whom are licensed, certified, or otherwise lawfully qualified to practice their
professions in the State of California, and

 

WHEREAS,
IPA desires to have ProMed HCA provide management services and ProMed HCA is
willing to provide such services, under the terms and conditions set forth in
this Agreement.

 

NOW,
THEREFORE, in consideration of the mutual covenants and conditions hereinafter
set forth and in exchange for good and valuable consideration, the-receipt and
sufficiency of which are hereby acknowledged, the parties agree as follows:

 

1.                                     Services to be
Performed and Manner of Performance. ProMed HCA shall perform
the services set forth in the “Fees and Services Exhibits”, Exhibit II
which is an essential part of this Agreement.  
The services required to be performed by ProMed HCA shall be limited to
the services set forth in the “Fees and Services Exhibits”, Exhibit II.
ProMed HCA shall perform said services consistently with the terms and
conditions of the contracts between IPA and its contracting Payers and within
the framework of the policies, interpretations, rules, practices and procedures
made or established by IPA, provided that such terms and conditions are made
known to ProMed HCA and are consistent and compatible with the description of
services set forth in the “Fees and Services Exhibits”, Exhibit II, and
with all applicable state and federal laws and regulations,

 

2.                                     Facilities and
Personnel.  ProMed HCA shall
maintain the facilities and personnel necessary to provide the services to be
performed by it under this Agreement

 

3.                                     Fees.  IPA agrees to pay to ProMed HCA for the
services provided under this Agreement the fees set forth on the “Fees and
Services Exhibits”, Exhibit I, which is an essential part of this
Agreement.

 

4.                                     Payer. Payer shall
be defined as the managed care or health maintenance organization (“HMO”),
government agency, employer or other organization which has entered into an
agreement with IPA under which IPA provides medical services to employees,
members or Enrollees (“Enrollees”) based on payments made by the Payer, subject
to the benefits, co-payments, limitations and exclusions set forth in the
agreement between the Payer and Enrollees. 
Payer may also be any other payment source including but not limited to,
Enrollees, coordination of benefits curriers, reinsurance and stop loss
carriers, institutional providers; ancillary providers and third party
liability payers.

 

1

 

5.                                       IPA’s Plan
Account. The contract between IPA and its contracting Payer shall establish a
set of benefits and other provisions which, for the purposes of this Agreement
will be referred to as a “Plan”. ProMed HCA shall establish a Plan Account to
he used to pay claims arising under the Plan. Payments made from Plan Account
will be in the amount of covered claims’ charges currently paid by ProMed HCA,
plus fees agreed upon in the attached Exhibits. It will be the IPA’s responsibility
to maintain funds in this special account sufficient to cover such
reimbursements.

 

6.                                       Term.  The term of this Agreement shall be for a
period of seven (7) years, commencing October 1,2002 and ending September 30,
2009 and shall be automatically renewed for successive one (1) year
periods, unless terminated as hereinafter provided.

 

7.                                       Termination.

 

A.                               Without Cause: After the
first anniversary date of this Agreement, either party shall have ,the right to
terminate this Agreement without cause, effective on any subsequent anniversary
date, by giving the other party advance written notice at least one hundred
twenty (120) days prior to the anniversary date.  Upon termination of this Agreement, for such
time that ProMed HCA may continue processing claims, IPA shall pay to ProMed
HCA for such services the fees specified in the attached “Fees and Services
Exhibits”, Exhibit I, and in the body of this Agreement.

 

B.                                 With Cause.  ProMed HCA may terminate this Agreement
immediately upon delivery of written notice if:

 

1.                                     IPA is unable
to lawfully operate under its articles of incorporation and bylaws, or

 

2.                                     IPA or a
substantial number of its member physicians are unable to secure and maintain
the required professional liability insurance, or

 

3.                                     In the event of
a commission of a material fraudulent act by IPA.

 

C.                                 Either party
may terminate this Agreement for cause by providing thirty (30) days written
notice to the other party specifying material breach of the provisions of this
Agreement. The remedy of such breach will result in the uninterrupted
continuance of the Agreement within the remaining term, provided that such
remedy occurs within twenty (20) days of the receipt of such notice, or if the
breach is failure by IPA to make payments required under this Agreement, then
within ten (10) days of the receipt of such notice. Circumstances beyond
the control of either party, such as acts of God, shall not be construed as
constituting material breach of this Agreement.

 

D.                                The Parties
agree that significant time and effort has been spent by ProMed HCA in the
development of managed care agreements and in the maintenance of said managed
care agreements.  IPA also understands
and agrees this is an on-going, time consuming process, and that in the event
of termination of this Agreement.

 

1.                                   By IPA without
cause, IPA shall pay to ProMed HCA, or;

 

2.                                   By ProMed HCA
for cause, IPA agrees to pay to ProMed HCA:

 

An amount equal to one hundred (100%) percent of the IPA’s total Gross Revenue
collected in the twelve (12) months prior to the termination date.

 

2

 

E.                                 If IPA
terminates this Agreement without cause or if ProMed HCA terminates this
Agreement with cause) IPA shall be responsible to continue payment of ProMed
HCA Management Fee in effect at the time of termination, for a period of one (1) year
following termination of Agreement.

 

The
above-referenced payments in case of termination of this Agreement, stated in Section D
above, shall not apply if IPA terminates this Agreement due to the sale of all
or substantially all of the stock or assets of IPA to another entity which also
holds a Management Services Agreement with ProMed HCA.

 

8.                                       Liabilities and
Obligations.  ProMed HCA
shall have no responsibility, risk, liability or obligation for the funding of
the Plan or for any extended liabilities for the Plan whether resulting from
the termination of the Plan or from a change to fully or partially insured
funding methods. Such responsibility, risk, liability or obligation shall
reside solely with IPA, IPA’s contracting Payer and such other entities as are
designated in the Plan.

 

9.                                       Indemnification. ProMed HCA
shall indemnify and hold harmless IPA against any loss, claim or judgment,
including reasonable attorneys’ fees, resulting from the negligent acts or
omissions or willful misconduct of ProMed HCA.

 

IPA agrees to indemnify and hold harmless ProMed HCA
against any expenses, loss, claim or judgment, including reasonable attorneys’
fees, arising out of or resulting from negligent acts or omissions or willful
misconduct of IPA.

 

In addition, IPA shall indemnify and hold harmless
ProMed HCA for losses, claims or judgments arising out of ProMed HCA’s
performance of its services hereunder where ProMed HCA has substantially adhered
to the framework of policies and procedures made or established by IPA and made
known to ProMed HCA and has otherwise performed its services without gross
negligence or willful misconduct and in accordance with industry practices.

 

10.                                 Accounting
Records. If requested by IPA, ProMed HCA shall prepare and maintain records of
the accounting of the Plan funds based upon information provided to ProMed HCA
for this purpose by IPA.  ProMed HCA
shall make such records available within forty-five (45) days of the end of the
calendar month in question. Said records are defined in the “Fees and Services
Exhibit”, Exhibit II, Sections 2 and 5.

 

11.                                 Professional
Services. Except as otherwise specifically provided in any
services exhibit attached hereto, ProMed HCA shall not be required to provide
any legal or other professional services to IPA nor shall ProMed HCA be
responsible for providing the services of an independent accountant, actuary or
auditor.

 

12.                                 Additional
Services. Without the prior written approval from ProMed
HCA, IPA shall make changes in the Plan effective only on the anniversary dates
of the documents governing the Plan, unless otherwise required by applicable
law or regulation. In the event such changes require additional services to be
performed by ProMed HCA, the cost of such services shall be home by IPA and
upon approval by IPA, such costs will be deducted by ProMed HCA from Plan
Account.

 

13.                                 Books and
Records.  ProMed HCA shall maintain all
records pertaining to the services to be performed by it hereunder.  ProMed HCA shall disclose the information of
such records only to IPA or as designated in writing by IPA to IPA’s designee
or to a person who has obtained an order of a court of competent jurisdiction
requiring such disclosure.

 

Upon
termination of this Agreement, ProMed HCA shall deliver to IPA, upon written
request within a time period mutually agreeable, but in no event greater than
six (6) months from the date of termination, information on all claim
histories for the two (2) years immediately
preceding the termination of this Agreement 

 

3

 

if
ProMed HCA has provided administrative services under this Agreement and/or all
files and documents pertaining to consulting services if ProMed HCA has
provided consulting services under this Agreement.

 

If such information or claim histories is so
requested, the IPA agrees to pay all costs incurred by ProMed HCA in providing
such information and records, including but not limited to, the costs of programming
computer changes and mailing. If additional information is requested by IPA
subsequent to the termination of this Agreement, ProMed HCA shall take
reasonable steps to provide such information and IPA agrees to pay all costs
incurred by ProMed HCA in providing such information, including but not limited
to, the costs of programming computer changes and mailing. ProMed HCA shall be
entitled to retain copies of all such records at its own expense,

 

14.                                 Independent
Contractor.  It is
understood and agreed by the parties hereto that ProMed HCA is engaged to
perform under this Agreement as an independent contractor and there is no
employee-employer relationship between the parties, nor is there any intent to
form any attachment or affiliation between the parties as a result of this
Agreement not specified in this Agreement.

 

15.                                 Assignments. Neither party
shall assign nor delegate to any other person or entity the duties, obligations
Or responsibilities imposed upon it by this Agreement without the prior written
approval of the other party, except that ProMed HCA may assign such duties,
obligations and responsibilities to a parent or subsidiary or successor of
ProMed HCA upon thirty (30) days written notice to IPA.

 

16.                                 Entire
Agreement: Amendments. This Agreement including the exhibits
hereto and any amendment hereto, contains the entire agreement between the
parties, and all prior proposals, discussions and writings by and between the
parties and related to the subject matter hereof are superseded hereby. This
Agreement may be modified or amended only pursuant to a written instrument
executed by both parties hereto, except that the parties agree to be bound by
applicable provisions mandated by state and federal law that are proposed in
good faith by either party as amendments to this Agreement.

 

17.                                 Compliance with
State and Federal Laws. If any provision of this Agreement or any
portion thereof is declared invalid or unenforceable, the remaining provisions
shall nevertheless remain in full force and effect, This Agreement shall be
interpreted under the laws of the State of California.

 

IPA
shall cooperate in all audits, applications, licensure, and compliance matters
necessary for ProMed HCA to comply with state and Federal law, and with the
requirements of industry accreditation bodies.

 

18.                                 Force Majeure.
Notwithstanding any provision of this Agreement to the contrary, neither ProMed
HCA nor IPA shall have any liability to the other for a failure of performance
resulting from any cause beyond its control.

 

19.                                 Enforcement
Overpayment. ProMed HCA shall have neither the responsibility
nor the obligation to take any action, legal or otherwise, against IPA or any
participant in the Plan or other person to. enforce the provisions of the Plan.
In the event that IPA desires to engage the services of ProMed HCA for such
purposes, such services may be engaged in and rendered only pursuant to a
separate written agreement between the parties.

 

20.                                 Expenses. Except as
specifically otherwise provided in this Agreement, IPA shall be solely
responsible for the normal and usual costs and expenses incurred in providing
the services contemplated. ProMed HCA shall be responsible for paying the costs
and expenses incurred in connection with the maintenance and operation of its
facilities. IPA shall be responsible for the payment of all costs attributable
to professional services contracted for or in connection with the
administration of IPA or by ProMed HCA at the direction of IPA.

 

4

 

21.                                 Arbitration. Any dispute
arising under this Agreement that cannot be settled by the parties may be
referred by either party for binding Arbitration under the commercial rules of
the American Arbitration Association, in Los Angeles County, California, and
the judgment of such arbitration may be entered in any court of competent
jurisdiction.

 

22.                                 Confidentiality. The parties
agree that the information processed and the work performed under this
Agreement is of a confidential nature. 
ProMed HCA shall provide and IPA shall acknowledge receipt and
acceptance of ProMed HCA’s policies and procedures regarding maintenance of
Confidentiality of information.  ProMed
HCA shall receive ninety (90) days notice from IPA prior to implementation of
any request by IPA for the revision or addition of systems and/or procedures
under this paragraph.

 

23.                                 Notices. Any notice
required to be given pursuant to the terms of this Agreement shall be in
writing and shall be hand delivered or sent, postage prepaid, by certified or
registered mail, return receipt requested, to ProMed HCA or IPA at the
addresses set forth below in the signature section. The notice shall be
effective on the date delivered by hand or the date of delivery indicated on
the return receipt.

 

IN WITNESS WHEREOF,
the parties hereto have signed this Agreement effective the date first written
above.

 

	
   

  	
  PRO MED HEALTH 

  CARE ADMINISTRATORS

  	
   

  	
   

  	
  UPLAND MEDICAL GROUP, A 

  PROFESSIONAL MEDICAL CORPORATION

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  By:

  	
   

  	
   

  	
   

  	
  By:

  	
   

  
	
   

  	
  Kishan Thapar, M.D.

  	
   

  	
   

  	
   

  	
  Jeereddi A. Prasad, M.D.

  
	
   

  	
  Executive Director

  	
   

  	
   

  	
   

  	
  President

  
	
   

  	
   

  	
   

  	
  Dated:

  	
   

  
	
  Dated:

  	
   

  	
   

  	
   

  	
  Upland Medical Group, A Professional

  
	
   

  	
  ProMed Health Care Administrators

  	
   

  	
   

  	
  Medical Corporation 

  
	
   

  	
  1154 N. Mountain Ave.

  	
   

  	
   

  	
  1154 N.Mountain Avenue 

  
	
   

  	
  Upland, CA 91786

  	
   

  	
   

  	
  Upland, CA 91786 

  
	
   

  	
   

  	
   

  	
   

  	
  Tax ID# 46-0503153

  
										

 

THIS AGREEMENT IS SUBJECT TO THE SERVICES AND
FEES EXHIBITS

ATTACHED HERETO AND MADE A PART HEREOF

 

5

 

FEES AND SERVICES EXHIBITS

 

EXHIBIT I - FEES

 

FEES

 

	
  1.

  	
  Management
  Fees: ProMed
  HCA shall calculate IPA Management Fees on a monthly basis, for services
  provided under this Agreement. Management Fees shall be a percentage of Gross
  Revenue as defined below and shall be calculated prior to the payment of
  Other Liabilities and Costs of Health Care Services of IPA.

  
	
   

  	
   

  	
   

  
	
   

  	
  ProMed HCA shall retain from IPA Gross Revenue the
  following amounts after calculation of all IPA expenses and liabilities:

  

 

	
  LINE OF BUSINESS

  	
   

  	
  PERCENTAGE

  
	
  Commercial

  	
   

  	
  12%

  
	
  Point
  Of Service

  	
   

  	
  12%

  
	
  Medicare
  Risk

  	
   

  	
  12%

  
	
  Medi-Cal

  	
   

  	
  12%

  
	
  Healthy
  Families

  	
   

  	
  12%

  

 

	
   

  	
  “Gross
  Revenue is defined as the total amounts actually received from all Payers on
  a capitated per member per month basis prior to any deductions, plus the
  total amounts actually received from all other payment sources. Payment sources
  shall include but are not limited to; capitation payments, risk sharing fund
  payments, any other incentive funds, third party liability recoveries, any
  other recoveries, and stop loss recoveries in excess of the stop loss
  premium.” 

  
	
   

  	
   

  
	
   

  	
  Plus:

  
	
   

  	
   

  
	
  2.

  	
  Affiliation
  Agreement: IPA
  may choose to sign an “Affiliation Agreement” with Pomona Valley Medical
  Group, Inc., dba. ProMed Health Network (“PMPV”). The purpose of this
  agreement will be to pass through HMO Enrollees from ProMed Health Network to
  the IPA, upon HMO acceptance and approval of Affiliation Agreement. By
  execution of an Affiliation Agreement, the IPA will become an affiliated IPA
  to PMPV (“Affiliated IPA”). The Affiliated IPA win be charged a fee
  (“Affiliation Fee”) of fifty ($0.50) cents PMPM (per Member Per Month) for
  each Enrollee, until such time as IPA executes their own HMO agreements and
  the Enrollees are formally transferred to IPA.

  
	
   

  	
   

  
	
   

  	
  All
  Enrollees assigned to Affiliated IPA under the PMPV HMO agreements shall be
  managed and administered as separate and distinct Enrollees to the
  IPA. All revenue and costs incurred by this membership shall be the
  responsibility of the Affiliated IPA, as defined in the Affiliation
  Agreement, Plus;

  
	
   

  	
   

  
	
  3.

  	
  Consulting
  Fees: When
  performed by an employee or affiliate of ProMed HCA, IPA shall pay ProMed HCA
  for consultation services (including travel expenses) not included in the
  services described in Exhibit II, on a “Per Project” or hourly rate of
  $150,00 per hour. Charges for Consulting Fees are due and payable by IPA upon
  receipt of an itemized statement from ProMed HCA, Plus;

  
	
   

  	
   

  
	
  4.

  	
  Other
  Fees:
  Additional fees for provision of hardware and software, not included in
  initial installation, will be quoted on a “Per Project” basis and agreed upon
  in writing between the parties prior to provision of said services. Charges
  for Other Fees are due and payable by IPA upon receipt of an itemized
  statement from ProMed HCA or shall upon approval by IPA, be deducted from
  lPA’s Plan Account.

  
	
   

  	
   

  
	
  5.

  	
  Timing
  and Manner of Payment: ProMed HCA shall deduct the Management Fees from IPA’s Plan Account
  on or before the twentieth (20th) day of each month.

  

 

6

 

FEES AND SERVICES EXHIBITS

EXHIBIT II - FEES

 

SERVICES TO BE PERFORMED BY PRO MED HCA

 

	
  1.

  	
  Claims

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Adjudication of claims for IPA’s services

  
	
   

  	
  b.

  	
  Upon written request by IPA, non-clinical assistance to reconcile
  problems between provider and patients

  
	
   

  	
  c.

  	
  Match claims to authorizations

  
	
   

  	
  d.

  	
  Print, sign and transmit medical service payment checks to
  Participating Providers

  
	
   

  	
  e.

  	
  Microfilm original claims

  
	
   

  	
   

  	
   

  
	
  2.

  	
  Claims Reports

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Prepare encounter data reports

  
	
   

  	
  b.

  	
  Prepare accounts receivable reports

  
	
   

  	
  c.

  	
  Prepare accounts payable reports (if applicable)

  
	
   

  	
  d.

  	
  Prepare month-end claims financial report as appropriate (i.e. lags
  and IBNR

  
	
   

  	
  e.

  	
  Provide claims utilization/encounter data reports to meet Payer
  requirements

  
	
   

  	
   

  	
   

  
	
  3.

  	
  Claims Support Activities

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Maintain vendor file (provider contract terms and IRS Form 1099
  tax information)

  
	
   

  	
  b.

  	
  Coordinate claims payment policy with IPA

  
	
   

  	
  c.

  	
  Manage cash balances for claims demand deposit account

  
	
   

  	
  d.

  	
  Order and implement customized software applications requested by
  IPA, at IPA’s expense

  
	
   

  	
   

  	
   

  
	
  4.

  	
  Eligibility

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Maintain and update eligibility records on a monthly basis

  
	
   

  	
  b.

  	
  Provide physician assignment and eligibility and retroactive detail
  reports, which coincide with payments to IPA physicians, on a monthly basis

  
	
   

  	
  c.

  	
  Prepare capitation payments per IPA guidelines to correspond with
  Payer eligibility and physician assignment

  
	
   

  	
  d.

  	
  Provide necessary eligibility verification consistent with that
  received from Payer

  
	
   

  	
   

  	
   

  
	
  5.

  	
  Accounting

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Provide information necessary for IPA’s accountant, to close medical
  expense journals and ledgers each month

  
	
   

  	
  b.

  	
  Bind and store computerized accounting reports, or microfiche reports

  
	
   

  	
  c.

  	
  Provide incentive distribution payments to IPA Physicians, at IPA’s
  direction

  

 

7

 

	
  6.

  	
  Authorizations

  
	
   

  	
   

  
	
   

  	
  a.

  	
  Provide on-line authorization services

  
	
   

  	
  b.

  	
  Provide authorization tracking and verification per IPA policy

  
	
   

  	
  c.

  	
  Assist in development of guidelines for authorization (i.e. second
  opinion, ancillary services, etc.)

  
	
   

  	
  d.

  	
  Provide trending comparison based on utilization of primary and
  specialty physicians

  
	
   

  	
  e.

  	
  Generation and distribution of authorization logs to provide
  notification to providers of authorization status, including Initial
  Determination for Medicare line of business

  
	
   

  	
  f.

  	
  Provide telephone authorization services during working hours and
  nurses by telephone for authorization services after working hours

  
	
   

  	
   

  	
   

  
	
  7.

  	
  Quality Assurance and Utilization Review

  
	
   

  	
   

  
	
   

  	
  a.

  	
  Provide supplemental nursing support services and triage services
  relative to Utilization Review and Quality Assurance

  
	
   

  	
  b.

  	
  Provide Monthly/Quarterly/Annual Quality Management reports

  
	
   

  	
  c.

  	
  Provide Daily/Weekly/Monthly Utilization Review reports for IPA’s
  Director/Board

  
	
   

  	
  d.

  	
  Assist Physicians and make Quality Assurance recommendations in Quality
  Assurance Review

  
	
   

  	
  e.

  	
  Administer grievance procedures, per Plan requirements

  
	
   

  	
   

  	
   

  
	
  8.

  	
  Credentials/Contracts

  
	
   

  	
   

  
	
   

  	
  a.

  	
  Assist IPA in development and implementation of credential guidelines

  
	
   

  	
  b.

  	
  Maintain credential and contract files for IPA Physicians

  
	
   

  	
  c.

  	
  Provide appropriate credential information to contract entities

  
	
   

  	
  d.

  	
  Assist in marketing IPA to Payers, negotiate and manage contracts

  
	
   

  	
  e.

  	
  Assist IPA in arranging and negotiating IPA contracts which include,
  but are not limited to: hospitals, home care, radiology, laboratory and other
  ancillary services

  

 

8

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00143-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00143-of-00352.parquet"}]]