EX-10.1 AMENDMENT NO. 11 TO CONTRACT
EX-10.1 2 g99523exv10w1.txt EX-10.1 AMENDMENT NO. 11 TO CONTRACT Exhibit 10.1 (AHCCCS LOGO) ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A. CONTRACT AMENDMENT
5. CONTRACTOR/PROVIDER NAME AND ADDRESS: HEALTH CHOICE ARIZONA 1600 W. BROADWAY, SUITE 260 TEMPE, ARIZONA ###-###-#### 6. PURPOSE; To add language to clarify Credit Balance Review Project requirements first presented in Amendment #7. 7. The above referenced contract is hereby amended as follows: A. Add the following language to the Credit Balance Review Project language presented in Amendment #7: "D. If the health plan/program contractor receives credit balance recovery funds from AHCCCS and at a later date recoups funds from the provider for the same service, the health plan/program contractor must repay the provider the lesser of the amount recouped or the credit balance recovery within 20 business days of being provided the documentation of the double recoupment by AHCCCS. A provider may request a refund of a double recoupment resulting from the credit balance recovery project for a period of 1 year after the second recoupment/payment." B. The Credit Balance Review Project term will run concurrent with the remainder of this contract, not to exceed March 4, 2008. NOTE: Please sign and date both and return one original to: Gary L Callahan, Contract Management Supervisor AHCCCS Contracts and Purchasing 701 E, Jefferson, MD 5700 Phoenix, AZ 85034 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT. 9. NAME OF CONTRACTOR: 10. ARIZONA HEALTH CARE COST CONTAINMENT HEALTH CHOICE ARIZONA SYSTEM SIGNATURE OF AUTHORISED INDIVIDUAL: SINGNATURE: /s/ CAROLYN ROSE /s/ MICHAEL VEIT - ------------------------------------- ---------------------------------------- TYPED NAME: CAROLYN ROSE TYPED NAME: MICHAEL VEIT TITLE: CHIEF EXECUTIVE OFFICER TITLE: CONTRACTS AND PURCHASING ADMINISTRATOR DATE: 9/6/2005 DATE: AUG 24 2005
