COMMISSIONERS COURT COMMUNICATION

Transcription

1 COMMISSIONERS COURT COMMUNICATION AGENDA DATE : CONSENT OR REGULAR: Consent CONTRACT REFERENCE NO (IF APPLICABLE): \ SUBJECT: Electronic Data Interchange System for Mental Health Support Services Department. BACKGROUND/DISCUSSION OF TOPIC: To include statutory requirement, operational impact, or performance goal. Electronic Data Interchange (EDI) system works in conjunction with an Electronic Medical Record System (EMR). The EDI electronically transmits encounter data to Medicaid for billing. Purchasing Department reviewed multiple EMRs and approved Smoky Mountain Informations Systems, Inc.( ) which collaborates with Gateway EDI to provide a full electronic records and billing system. This request is for the EDI component. The EMR is on Commissioners Court separately for September 17, 2012 This EDI meets EL Paso County system requirements. The purchase of this system is directly in line with the Department's sustainability goal in the Management Action Plan (MAP). FISCAL IMPACT: Fiscal annual impact is $ with a $ one time start-up fee. Total fiscal impact $1, PRIOR COMMISSIONERS COURT ACTION (IF ANY): N/A RECOMMENDATION: Approve and authorize the County Judge to sign a Software License Agreement with Gateway EDI for an electronic data interchange system for Mental Health Support Services Department. The electronic data interchange system is utilized for electronic Medicaid billing with a fiscal impact of $1, COUNTY ATTORNEY APPROVAL The attached document has been given legal review by the El Paso County Attorney s Office on behalf of the County of El Paso, it officers, and employees. Said legal review should not be relied upon by any person or entity other than the County of El Paso, its officers, and employees. COUNTY ATTORNEY: LEGAL REVIEW: LEGAL REVIEW NOTES (If Applicable): DATE: SUBMITTED BY: Rita Ruelas- Director- Mental Health Support Services carmarquez@epcounty.com APPROVED 12/19/2011

2 From: To: Cc: Subject: Date: Attachments: Kevin McCary Carlos Marquez Alicia Vera; Josefina Vasquez; Kevin McCary Gateway EDI approval. Tuesday, August 14, :05:57 PM License Agreement- El Paso County Depart of Mental Health Support Services Approved for Court.pdf This contract has been approved. Please place it on the Comm. Court agenda at your convenience. Please included the amended contract in the back-up. *** COUNTY LEGAL REVIEW FORM Contract Description: Gateway EDI/PIMSY/Mental Health Support Services (MHSS) License Agreement. COUNTY ATTORNEY ACTION** **Requested Amendments/Clarifications: We assume you have submitted any questions or comments you have regarding the terms of the contract, as well as any specific provisions to which you object, or which you want to have changed. Approved as to Form as Submitted X Approved as to Form with Amendments/Modifications/Reservations Noted Below* Not Approved Start date clarified. Indemnity provision removed. This document has been given legal review by the El Paso County Attorney s Office on behalf of the County of El Paso, its officers, and employees. Said legal review should not be relied upon by any person or entity other than the County of El Paso, its officers, and employees. Kevin McCary Assistant County Attorney

3 Kevin McCary Assistant County Attorney General Counsel Unit Jo Anne Bernal, County Attorney 500 E. San Antonio, Suite 503 El Paso, TX V: F:

4 LICENSE AGREEMENT THIS LICENSE AGREEMENT (the Agreement ) is made and entered into as of the OCTOBER 1, 2012, between GATEWAY EDI, LLC, a Delaware Company, and El Paso County Depart of Mental Health Support Services 500 East San Antonio Suite 311, El Paso TX (hereinafter "CLIENT"), concerning the use by CLIENT of GATEWAY EDI s Electronic Data Interchange (EDI) system (the System ). 1. Financial Agreement. (a) Effective as of the date of this Agreement, GATEWAY EDI will support FTP or Website processing of healthcare transactions between the CLIENT and governmental agencies, insurance carriers and other companies by either electronic or paper means. (b) All CLIENT information and data processed by the CLIENT through FTP or the Website shall be kept confidential and shall not be disclosed to anyone outside of GATEWAY EDI other than to the extent necessary for GATEWAY EDI to process and submit healthcare transactions for the CLIENT. In addition, CLIENT will not divulge the contents, terms or conditions of this Agreement to any third party without the express written consent of GATEWAY EDI. (c) CLIENT will pay GATEWAY EDI an initial setup fee of $100 to cover the cost of setting up the CLIENT in the System. This initial setup fee will be due and payable on the date this Agreement is signed. This initial setup fee is non-refundable. Thereafter, CLIENT will pay an additional setup fee of $0 for each new provider employed or retained by CLIENT after the initial setup is completed. (d) CLIENT will pay GATEWAY EDI the package pricing listed on APPENDIX A attached to this Agreement ( Package Pricing ) for the service package selected by CLIENT on APPENDIX A ( Service Package ). CLIENT will also pay GATEWAY EDI the per item pricing listed on APPENDIX A ( Per Item Pricing ) for the per item services, if any, selected by CLIENT on APPENDIX A ( Per Item Services ). The Package Pricing and the Per Item Pricing listed in this Agreement and its APPENDIX are guaranteed for a period of one (1) year after the date of the Agreement. Thereafter, GATEWAY EDI reserves the right to modify the Package Pricing and the Per Item Pricing payable under this Agreement upon thirty (30) day written notice to client and GATEWAY EDI reserves the right to charge the CLIENT for custom programming, file mapping and specialized service requests incurred 90 days after service implementation. (e) GATEWAY EDI will invoice CLIENT for its services on the first day of each month for the selected EDI transactions for the current month and any activity fees for the previous month. CLIENT will pay GATEWAY EDI for its services within fifteen (15) days of the invoice date. If a payment is not received by Gateway EDI within 30 days after the Due Date(s), Gateway EDI may charge the applicable interest rate under the Texas Prompt Pay Act, pursuant to Texas Government Code Chapter Failure to make payment within 120 days will result in CLIENT s account being turned over to a collection agency at which point CLIENT will also be responsible for any and all charges associated with collections on CLIENT s account to the extent permitted by the Texas Prompt Payment Act. In addition to the foregoing, GATEWAY EDI shall be entitled to suspend or terminate the performance of its services under this Agreement during any period in which invoices are past due, without incurring any liability to CLIENT. GATEWAY EDI s services are a subscription service, and as such Client will pay claims transaction fees regardless of the volume of claims sent. (f) In addition to the other amounts invoiced by GATEWAY EDI and payable by CLIENT under this Agreement, GATEWAY EDI will invoice CLIENT for an annual renewal fee of $200 upon the renewal of this Agreement. Such invoice shall be payable by CLIENT within fifteen (15) days of the invoice date. (g) Taxes. Client will be responsible for any taxes, duties, fees or surcharges that are imposed or authorized by regulatory and governmental entities, and shall pay to Gateway EDI or reimburse Gateway EDI for such amounts as are paid by Gateway EDI relating to the Services provided to Client. Notwithstanding the foregoing, COUNTY is a tax exempt Political Subdivision of the State of Texas and its Tax Identification Number is COUNTY shall not be liable for any taxes for which it is otherwise exempt. 2. GATEWAY EDI Training. Training on claims transmission and data management reports will be provided by GATEWAY EDI to CLIENT via telephone. 3. Hours of Operation. j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health

5 (a) GATEWAY EDI s System will be available, except when technical problems intervene, for submission of claims, extracting remittances, reports, updates, etc., twenty-four (24) hours a day. GATEWAY EDI s System may be down Sunday mornings for maintenance. (b) Electronic claims are processed daily until 2:00 pm Central Time. All claims received after 2:00 pm Central Standard Time will be processed on the next business day. Claims reports will be available by 10:00 am Central Standard Time for all prior day submissions. Remits received from payers are processed and available within twenty-four (24) hours of receipt. (c) GATEWAY EDI s customer service department is available for support Monday through Friday, 7:00 a.m. to 6:00 pm Central Time, excluding holidays. After-hours support will be provided on a best-effort basis, normally within four (4) business hours of the call. 4. Term. (a) The term of this Agreement shall begin on October 1, 2012 and continue for a period of one (1) year. This Agreement shall automatically renew for successive one (1) year terms. This Agreement can be terminated by either party, at any time, for any reason, by giving the other party thirty (30) days advanced written notice. CLIENT will continue to be billed for GATEWAY EDI s services until the end of such thirty (30) day period. Said notice must include CLIENT s reasons for terminating the Agreement. (b) CLIENT is responsible for notifying GATEWAY EDI of any providers which require termination from the System. CLIENT will continue to be billed for such providers until such time that CLIENT provides such notice, and any amounts paid for these providers are considered non-refundable. 5. HIPAA Compliance. GATEWAY EDI shall comply with all applicable requirements of the HIPAA Privacy and Security Rules, 45 C.F.R. Parts 160 and 164, in the performance of this Agreement. At CLIENT's request, GATEWAY EDI shall enter into a business associate agreement with CLIENT consistent with applicable regulatory requirements. 6. Force Majeure. Neither the CLIENT nor GATEWAY EDI shall be responsible for failure to fulfill its obligations under this Agreement due to causes beyond its reasonable control. 7. Governing Law. This Agreement will be governed by the laws of the state of Texas. Dispute arising hereunder not resolved by the parties shall be litigated in a court situated in El Paso, Texas. 8. DISCLAIMERS AND LIMITATIONS OF LIABILITY. EXCEPT AS OTHERWISE SET FORTH HEREIN, THERE ARE NO WARRANTIES, WHETHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IN NO EVENT SHALL GATEWAY EDI BE LIABLE FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, OR EXEMPLARY DAMAGES, LOST PROFITS, OR CLAIMS BY THIRD PARTIES, EVEN IF GATEWAY EDI HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN ANY EVENT, GATEWAY EDI SHALL NOT BE LIABLE FOR ANY LOSS OR DAMAGE EXCEEDING ALL AMOUNTS PAID BY CLIENT TO GATEWAY EDI HEREUNDER. 9. Acknowledgments. CLIENT is responsible for the completeness and accuracy of all information and data generated through the QEDI processing system and CLIENT acknowledges that GATEWAY EDI has had no input with respect to such information and data. 10. Notice. Any notice required or permitted to be given under this Agreement shall be sufficient if in writing and shall be deemed given when personally delivered or two (2) days after deposited in the United States mail, certified mail, return receipt requested, and addressed to the appropriate party at the address listed below. 11. No Third Party Beneficiaries. There are no intended third party beneficiaries to this Agreement. Without in any way limiting the foregoing, it is the parties intent that nothing contained in this Agreement give rise to any right or cause of action, contractual or otherwise, in or on behalf of any person whose PHI or EPHI is used or disclosed pursuant to this Agreement or any person who qualifies as a personal representative of such person. 12. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the parties hereto as well as their respective heirs, assigns, and successors in interest. 13. Entire Agreement. This Agreement constitutes the entire agreement between the parties relative to the subject matter. j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health

6 14. Modification. No amendment or additions to this Agreement shall be binding unless in writing and signed by both parties. 15. Guarantee. GATEWAY EDI guarantees that we will be able to reduce CLIENT s rejection rate within 90 days. If CLIENT is not 100% satisfied with GATEWAY EDI s customer service OR ability to lower CLIENT S rejection rate after 90 days, Gateway EDI will issue a refund for services provided* and GATEWAY EDI will pay for CLIENT to switch to another clearinghouse.** IN WITNESS WHEREOF, the parties have executed this Agreement on the date first set forth above. GATEWAY EDI GATEWAY EDI, LLC CLIENT El Paso County Depart of Mental Health Support Services By: By: Printed: Jessica Ramsey Printed: Title: Regional Account Executive Date: August 14, 2012 Title: Date: Address: Address: 500 East San Antonio Suite 311 St. Louis, Missouri El Paso, TX Please initial next to services desired on Appendix A (next page). * Refund excludes all applicable postage costs. ** GATEWAY EDI will pay CLIENT s initial set-up fee with another clearinghouse, not to exceed $500. j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health

7 Appendix A to Gateway EDI License Agreement Customer Name: El Paso County Depart of Mental Health Support Services City: El Paso State: TX Phone: (915) Please INITIAL next to the desired services below*: Electronic claims: The CLIENT will pay GATEWAY for the use of GATEWAY EDI s clearinghouse to submit electronic claims to payers on the Approved Payer List based upon the following fee schedule: $ monthly minimum for up to 200 claims, $0.39 per claim thereafter Also included in the above fees, are the following services: Individual Claim Status Inquiry The CLIENT, using GATEWAY EDI s Internet CSI, will be able to check the status of any claims submitted to Gateway EDI free of charge for Participating Payers (Non-participating payers will be charged at $0.25 per inquiry) Paper claims: The CLIENT will electronically send claims to GATEWAY EDI to be printed and forwarded to payers at a fee of $0.61/claim. Paper claims are filed for any insurer s claims received by GATEWAY EDI that are not on the Approved Payer List, or for claims received for payers to which the provider has not yet been approved to send electronic claims. Electronic Remittance Advice: GATEWAY EDI will electronically send to the CLIENT ERA files received from payers (when available). The CLIENT agrees to pay GATEWAY EDI $25/200 claims/month for this service. Automated Secondary Claims: Provided the CLIENT is currently using GATEWAY EDI s Electronic Remittance Advice service (not required for COB Pass Thru Secondaries) and CLIENT can send the secondary payer information, Gateway EDI will create secondary claims when necessary, submit them electronically if applicable, or print and mail the secondary claims to the secondary carriers not set up for electronic submission, for a fee of $0.84 per claim. Batch Eligibility/Web Services 400 Eligibility inquiries for participating and non-participating payers for $ 29 per month, $.07 per inquiry thereafter. Patient Exchange Web Portal Only $ 15 monthly fee Standard Online Payment Fees, billed and collected by TransFirst Health Services, Inc. $ 9.95 per month per Merchant ID Fee 2.5% Card not Present Rate $.25 per credit card/debit card transaction $.35 per ACH transaction I am interested in receiving more information regarding Gateway EDI s Credit Card Services from TransFirst. *Gateway EDI reserves the right to adjust pricing set forth herein to reflect any future changes in postal rates. These fees do not apply to existing Gateway EDI Credit Card customers j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health

8 ACH AUTHORIZATION FORM WE OFFER FREE ACH (AUTOMATED CLEARINGHOUSE) SERVICE TO HELP EASE SOME OF YOUR STRESS Here s how it works With Automatic Payment from Gateway EDI LLC your monthly invoices will be paid from your bank account. You will continue to receive your Gateway EDI invoices but instead of writing a check, simply deduct the amount from your bank account. Your bank statement will reflect your payments as a separate transaction, so you ll always have a record. The Automatic Payment system will take care of transferring the correct payment amount directly from your bank to your Gateway EDI account. There are no late fees or lost checks and your payments are made precisely on an agreed upon date. To activate the Automatic Payment program, complete this blank form and we will take care of the rest. Automatic Payment (ACH) Activation Form Complete all of the following information and FAX or mail along with a voided check. I authorize the financial institution named to charge my (name of bank your office uses) Checking or Share Draft Account Savings Account (not passbook) Name of Bank Account Holder Bank Account Number ABA/Routing Number And remit payment for my invoices to:, First Bank, ACH account Monthly to begin mm/yy (Payment to be taken out the 20th of each month) One time transaction of $ 100 on date Authorized Signature Date Printed Signature Note: A test will be performed before activation is completed and your statement will show ($000). Please don t be alarmed! FAX this form with a copy of your voided check to: (314) OR Mail this form with your voided check to: Sales Dept. Saint Louis, MO For assistance, please call and ask for Sales. j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health

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10 Credit Card Authorization Form We accept MasterCard, Visa and AMEX as a payment option for your Set-up Fee(s). To have your credit card charged for your Set-up Fee, we MUST have the following signed statement on file. Accounts will be charged within 7 business days of receipt. PLEASE PRINT Site Name Mental Health Support Services Name as is appears on the Credit Card Street Address where statement is received City, State where statement is received Zip Code where statement is received Telephone # (including area code) Fax # (including area code) El Paso County Depart of Set-up Fee Amount $100 Credit Card Type (Please circle): VISA MasterCard AMEX V/MC Card #: Exp Date: / V-Code (3 digits on card back) AMEX Card # - - Exp Date: / V-Code (4 digits on card front) I authorize to charge the credit card listed about for the initial Set-up Fee for my account. CARD HOLDER SIGNATURE Name (signed) Name (printed) Date PERSON COMPLETING THIS FORM Name (signed) Name (printed) Date j:\gc\wprocess\contracts-executed.pdf\2012.kk\ license agreement- el paso county depart of mental health