Sign Up Step 2
Step 1 is complete! For Step 2, please read and sign the following below:
1. Service Agreement: MediClaims will create and process your claims quickly and efficiently.
2. Business Associate Agreement: MediClaims will provide confidential, HIPAA-compliant, secure services.
2. Business Associate Agreement: MediClaims will provide confidential, HIPAA-compliant, secure services.
MediClaims Biller Service Agreement
This MediClaims Service Agreement (hereinafter, "the Agreement" or "Agreement") is entered into between MediClaims Billing LLC (hereinafter "MediClaims") and your company (hereinafter "the Client" or "Client"), both collectively referred to as "the parties".
WHEREAS MediClaims is a healthcare billing and service company which provides claims billing services to healthcare providers and which files medical insurance claims on behalf of healthcare providers by electronic and paper means; and
WHEREAS the Client desires to retain MediClaims to provide claims and billing services, whereby MediClaims will file insurance claims with government and commercial companies by electronic and paper means on behalf of the Client;
NOW, THEREFORE, in consideration of the promises and covenants contained herein and for other valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows:
WHEREAS MediClaims is a healthcare billing and service company which provides claims billing services to healthcare providers and which files medical insurance claims on behalf of healthcare providers by electronic and paper means; and
WHEREAS the Client desires to retain MediClaims to provide claims and billing services, whereby MediClaims will file insurance claims with government and commercial companies by electronic and paper means on behalf of the Client;
NOW, THEREFORE, in consideration of the promises and covenants contained herein and for other valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows:
- Commencing on the date this agreement is signed, MediClaims will begin the process of setting up the Client's healthcare insurance claims for payment by government and commercial companies by either electronic or paper means. The Client agrees to make available to MediClaims all information necessary to properly process the Client's claims and to submit all such billing and insurance information to MediClaims on a daily, weekly, or monthly schedule. In return, MediClaims will process and submit all the Client’s claims by electronic means wherever possible, and by paper means otherwise.
- All patient information and data provided by the Client to MediClaims shall be kept strictly confidential and shall not be disclosed to anyone outside of MediClaims other than to the extent necessary for MediClaims to process and submit claims for the Client. In addition, the Client will not divulge the contents, terms or conditions of this Service Agreement to any third party without the express written consent of MediClaims.
- The Client will pay to MediClaims a one-time nonrefundable account setup fee of $100 to cover the operation cost of gathering information from the Client and setting up the Client's files for entry into the MediClaims claims processing system. The information and initial setup covered by this initial fee includes, but is not limited to, provider and Facility profile; listing of insurance companies used; diagnosis codes; procedure codes; registration with the MediClaims processing system, etc.
- To keep the MediClaims account active, the Client will pay to MediClaims a one-rate subscription fee per claim per service, calculated based upon the number of claims submitted through our service. The actual invoiced flat-rate fee is determined before services start and is agreed upon in writing by the parties after determining the Client's claims processing needs. The Client agrees to provide copies of all Explanation of Benefits (EOB) forms received from insurance payers to MediClaims to verify claims processing.
- MediClaims shall provide to Client a report after claims are posted. The report will be sent from a secure MediClaims email. If not accessed on MediClaims servers, the report must be received by the Client on the Client's secure email to ensure closed-loop HIPAA compliance.
- MediClaims will close its books for invoice purposes on the last day of each month and will bill the client for its services on or before the third day of the succeeding month for the previous month's processing. The Client will pay MediClaims for its services upon receipt of receipt of MediClaims's invoice. If the Client fails to submit payment on or before the third day, the Client will be responsible for paying, in addition to the principal amount billed, a late fee will be added to the invoiced bill for 10% of the Client's monthly recurring charges.
- During the term of this Service Agreement, the Client agrees not to use the services of any other claims processing companies and will allow MediClaims to process all of the Client's medical insurance claims with the government and commercial companies, unless otherwise agreed upon by the parties in writing.
- Either party may terminate this Service Agreement at any time by providing a thirty (30) day written notice with explanation or reason why termination is desired to the other party.
- MediClaims will be serving as a conduit of information and claims data between the Client and many insurance payers, both government and commercial. The Client will be providing all such claims information and data to MediClaims, including but not limited to procedure codes, identifying the exact procedures the Client has performed on patients. The Client verifies and testifies that all such procedures were in fact performed on the patients as specified. MediClaims has no authority to and will not change any of these procedure codes without the express permission and direction of the Client.
- The Client understands that MediClaims is relying entirely on the claims and billing information supplied to MediClaims by the Client in preparing and submitting insurance claims for payment on behalf of Client. The Client warrants and represents that all such claims and billing information is entirely accurate and truthful. If any investigation is initiated or if any action is brought by any individual, company or entity whatsoever regarding any of the claims filed by MediClaims on behalf of the Client, then the Client agrees to cooperate fully in any such investigation or action and shall provide all relevant supporting documentation to support the claim(s) filed.
- The Client understands that MediClaims will not provide insurance pre-authorizations.
- The Client agrees to indemnify and hold MediClaims harmless for any and all damages or penalties imposed. Any attorney or court fees incurred by MediClaims in defending any such action resulting from the Client's failure to provide truthful and accurate billing and claims information to MediClaims will be paid for by the Client.
- This Service Agreement shall be interpreted under the laws of the State of North Carolina and any disputes between the parties concerning the validity, interpretation or performance of any of the terms or provisions of this Service Agreement or of any rights or obligations of the parties hereto shall be resolved in North Carolina. Should it become necessary for MediClaims to retain an attorney to collect any amounts owed to MediClaims under the terms of this Service Agreement, MediClaims will be entitled to recover, in addition to its damages, reasonable attorney and court fees from the Client.
- Any notices or communications anticipated by this Service Agreement shall be directed to the parties, as follows: MediClaims Billing LLC: 7413 Six Forks Rd, Ste 101, Raleigh, NC 27615. CLIENT: As undersigned.
- This Service Agreement, along with the attached Business Associate Agreement, represent the entire agreement between the parties and shall not be modified unless done so in writing signed by or on behalf of both parties.
- This Service Agreement shall be binding upon and inure to the benefit on the heirs, legatees, successors, and assigns of each of the parties.
MediClaims Biller Business Associate Agreement
This MediClaims Business Associate Agreement (hereinafter, "the Agreement" or "Agreement") is entered into between MediClaims Billing LLC (hereinafter, "MediClaims") and your company (hereinafter, " the Client" or "Client"), both collectively referred to as "the parties".
WHEREAS, MediClaims is a healthcare billing and service company which provides claims billing services to healthcare providers and which files medical insurance claims on behalf of healthcare providers by electronic and paper means; and
WHEREAS, the Business Associate desires to retain MediClaims to provide claims and billing services, whereby MediClaims will file insurance claims with government and commercial companies by electronic and paper means on behalf of the Business Associate;
NOW, THEREFORE, in consideration of the promises and covenants contained herein and for other valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows:
1. Business Associate agrees to:
(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;
(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;
(e) Make available protected health information in a designated record set to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity’s obligations under 45 CFR 164.526;
(g) Maintain and make available the information required to provide an accounting of disclosures to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.528;
(h) To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.
2. Permitted Uses and Disclosures by Business Associate
(a) Business associate may only use or disclose protected health information for the necessary processing of submitted services to generate claims and produce bills to be paid by the indicated payer(s), as necessary to perform the services set forth in Service Agreement. The business associate is authorized to use protected health information to de-identify the information in accordance with 45 CFR 164.514(a)-(c).
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information consistent with covered entity’s minimum necessary policies and procedures.
(d) Business associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164 if done by covered entity if the Agreement permits the business associate to use or disclose protected health information for its own management and administration and legal responsibilities or for data aggregation services as set forth in optional provisions (e) and (f).
(e) Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.
(f) Business associate may disclose protected health information for the proper management and administration of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures are required by law, or business associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies business associate of any instances of which it is aware in which the confidentiality of the information has been breached.
3. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
(a) Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate’s use or disclosure of protected health information.
(b) Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate’s use or disclosure of protected health information.
(c) Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate’s use or disclosure of protected health information.
4. Permissible Requests by Covered Entity
Covered entity shall not request business associate to use or disclose protected health information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by covered entity, with the exception of if the business associate will use or disclose protected health information for, and the agreement includes provisions for, data aggregation or management and administration and legal responsibilities of the Business Associate.
5. Term and Termination
(a) Term. The Term of this Agreement shall be effective as of date of signing, and shall terminate upon written agreement or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement and business associate has not cured the breach or ended the violation within the time specified by covered entity.
(c) Obligations of Business Associate Upon Termination.
Upon termination of this Agreement for any reason, business associate shall return to covered entity, or, if agreed to by covered entity, destroy, all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form. Business associate shall retain no copies of the protected health information.
Upon termination of this Agreement for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall:
6. Miscellaneous
(a) Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.
(b) Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.
(c) Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.
WHEREAS, MediClaims is a healthcare billing and service company which provides claims billing services to healthcare providers and which files medical insurance claims on behalf of healthcare providers by electronic and paper means; and
WHEREAS, the Business Associate desires to retain MediClaims to provide claims and billing services, whereby MediClaims will file insurance claims with government and commercial companies by electronic and paper means on behalf of the Business Associate;
NOW, THEREFORE, in consideration of the promises and covenants contained herein and for other valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows:
1. Business Associate agrees to:
(a) Not use or disclose protected health information other than as permitted or required by the Agreement or as required by law;
(b) Use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of protected health information other than as provided for by the Agreement;
(c) Report to covered entity any use or disclosure of protected health information not provided for by the Agreement of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware;
(d) In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions, conditions, and requirements that apply to the business associate with respect to such information;
(e) Make available protected health information in a designated record set to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.524;
(f) Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity’s obligations under 45 CFR 164.526;
(g) Maintain and make available the information required to provide an accounting of disclosures to the covered entity as necessary to satisfy covered entity’s obligations under 45 CFR 164.528;
(h) To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and
(i) Make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules.
2. Permitted Uses and Disclosures by Business Associate
(a) Business associate may only use or disclose protected health information for the necessary processing of submitted services to generate claims and produce bills to be paid by the indicated payer(s), as necessary to perform the services set forth in Service Agreement. The business associate is authorized to use protected health information to de-identify the information in accordance with 45 CFR 164.514(a)-(c).
(b) Business associate may use or disclose protected health information as required by law.
(c) Business associate agrees to make uses and disclosures and requests for protected health information consistent with covered entity’s minimum necessary policies and procedures.
(d) Business associate may not use or disclose protected health information in a manner that would violate Subpart E of 45 CFR Part 164 if done by covered entity if the Agreement permits the business associate to use or disclose protected health information for its own management and administration and legal responsibilities or for data aggregation services as set forth in optional provisions (e) and (f).
(e) Business associate may use protected health information for the proper management and administration of the business associate or to carry out the legal responsibilities of the business associate.
(f) Business associate may disclose protected health information for the proper management and administration of business associate or to carry out the legal responsibilities of the business associate, provided the disclosures are required by law, or business associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies business associate of any instances of which it is aware in which the confidentiality of the information has been breached.
3. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions
(a) Covered entity shall notify business associate of any limitation(s) in the notice of privacy practices of covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate’s use or disclosure of protected health information.
(b) Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate’s use or disclosure of protected health information.
(c) Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate’s use or disclosure of protected health information.
4. Permissible Requests by Covered Entity
Covered entity shall not request business associate to use or disclose protected health information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by covered entity, with the exception of if the business associate will use or disclose protected health information for, and the agreement includes provisions for, data aggregation or management and administration and legal responsibilities of the Business Associate.
5. Term and Termination
(a) Term. The Term of this Agreement shall be effective as of date of signing, and shall terminate upon written agreement or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.
(b) Termination for Cause. Business associate authorizes termination of this Agreement by covered entity, if covered entity determines business associate has violated a material term of the Agreement and business associate has not cured the breach or ended the violation within the time specified by covered entity.
(c) Obligations of Business Associate Upon Termination.
Upon termination of this Agreement for any reason, business associate shall return to covered entity, or, if agreed to by covered entity, destroy, all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form. Business associate shall retain no copies of the protected health information.
Upon termination of this Agreement for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall:
- Retain only that protected health information which is necessary for business associate to continue its proper management and administration or to carry out its legal responsibilities;
- Return to covered entity, or, if agreed to by covered entity, destroy, the remaining protected health information that the business associate still maintains in any form;
- Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of the protected health information, other than as provided for in this Section, for as long as business associate retains the protected health information;
- Not use or disclose the protected health information retained by business associate other than for the purposes for which such protected health information was retained and subject to the same conditions set out at Section 2, (e) and (f); and
- Return to covered entity, or, if agreed to by covered entity, destroy, the protected health information retained by business associate when it is no longer needed by business associate for its proper management and administration or to carry out its legal responsibilities.
6. Miscellaneous
(a) Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.
(b) Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.
(c) Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.