Managed Care Advisory Group, LLC (“MCAG”)
By signing the order form with NextGen Healthcare, Inc. that contains the above-mentioned third-party’s product or service, and/or clicking "I ACCEPT" or equivalent language when you or your organization first use the product or service set forth below, you and/or your organization are agreeing to the following terms and conditions that are directly between you and the third-party vendor (to the extent you are agreeing on behalf of your organization, you represent and warrant that you are authorized to do so):
1. Purpose of Agreement
This agreement secures the right for MCAG to provide CPRvista Service:
MCAG’s CPRvista is a contract payment review (CPR) service that includes access to MCAG’s proprietary, cloud-based reporting dashboard and advisory services in return for an annual maintenance fee and monthly subscription fees. In addition, CPRvista includes a contingent fee-based recovery component (the “CPRvista Services”). Any additional services from MCAG outside of MCAG’s CPRvista shall be obtained from, and agreed to by, Client and NextGen Healthcare via a separate addendum.
2. MCAG and Client Responsibilities
MCAG will provide CPRvista services to Client by comparing payments from Clients’ contracted payers to the contracts and fee schedules for these payers. During the performance of this contracted service, MCAG shall review client’s payer agreements for contractual underpayment errors. These errors include: under allowed payment variances, under billed charges based on insurer contractual terms, coding errors resulting in reduced payments, and failure to pay according to applicable Prompt Pay State Law and claim denials. The under allowed amount is based on the allowed amount specified in the payer contract, or related payment appendices.
MCAG will provide Client with a detailed document and data request. Client will provide documentation and disclosing information relating to the contractual relationship with their payers, including but not limited to proprietary fee schedules. MCAG shall review such information promptly. MCAG is responsible for working with Client to obtain all related contract and fee schedule documentation for the Client’s commercial payer agreements.
MCAG is also responsible for updating the CPRvista dashboard in a timely manner allowing the Client adequate time to review the contract payment review findings and authorize the appeals process for collecting any balance due. MCAG will also assign an Account Manager to each Client. The Account Manager will advise the Client on CPRvista results and potential recoveries on, at least, a quarterly basis.
MCAG will also build a profile of the client including, but not limited to: their physician providers, locations, contractual payer relationships, and billing practices.
Client is responsible for providing, or authorizing their Claims Clearinghouse vendor to provide, MCAG with electronic claim and remittance (837/835) data sets for contracted Client on an ongoing, timely basis to facilitate the analysis and payment recovery. Client must provide MCAG with a minimum of six (6) months of retrospective (837/835) data sets, with a daily feed of (837/835) data on a go forward basis.
3. Fees and Costs:
Annual Maintenance: Fee: As set forth in the Order Form between Client and NextGen Healthcare.
CPRvista Monthly Subscription: In addition to the Annual Maintenance Fee, the Client will be invoiced, by NextGen Healthcare, a monthly subscription fee for the CPRvista dashboard and a contingent fee for any recoveries performed by MCAG.
4. Term and Termination
The term of this agreement shall commence on the Fulfillment Date as set forth the applicable NextGen Healthcare/Client Master Agreement and shall continue for a period of one (1) year. Thereafter, the parties may elect to renew this agreement only upon mutual, written agreement. Client may terminate these Services upon sixty (60) days prior written notice to MCAG of such intent to terminate.
In the event of termination, Client agrees to pay MCAG the contingent fees set forth above for all accounts to which MCAG has been given information that are collected in whole or in part within one hundred eighty (180) days after termination. Upon termination, MCAG will supply Client with a list of active inventory which details accounts being worked by MCAG. During this one hundred eighty (180) day period, MCAG shall continue to receive or have access to the full claim and remit data sets described in Section 2 and receive the Client’s cooperation in bringing these claims to resolution.
If, for any reason whatsoever, the Client is unable to provide the services described herein, then this Agreement shall automatically terminate.
The Agreement is hereby ratified in all respects and shall remain in full force and effect.