Second Amendment to Contract YH09-0001-04 Between Arizona Health Care Cost Containment System and Health Choice Arizona

Contract Categories: Business Finance › Modification Agreements
Summary

This amendment updates the contract between the Arizona Health Care Cost Containment System (AHCCCS) and Health Choice Arizona. It outlines how claims and recoveries related to Blue Cross Blue Shield of Arizona (BCBSAZ) coverage data from January 15, 2006, to March 31, 2008, will be handled, including the division of recovered funds and vendor compensation. From April 1, 2008, Health Choice Arizona is responsible for coordinating benefits. All other terms of the original contract remain unchanged.

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EX-10.11 2 c92860exv10w11.htm EXHIBIT 10.11 Exhibit 10.11
Exhibit 10.11
     
  ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
SECTION A: CONTRACT
             
1. AMENDMENT
  2. CONTRACT   3. EFFECTIVE DATE OF   4. PROGRAM
NUMBER:
 
NO.:
  
AMENDMENT:
    
               2
  YH09-0001-04             January 15, 2009   DHCM — ACUTE
5. CONTRACTOR’S NAME AND ADDRESS:
Health Choice Arizona
410 N. 44TH Street, Suite 900
Phoenix, AZ 85008
6. PURPOSE OF AMENDMENT: To amend Section D.
7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:
  A.   Added to Paragraph 58, Coordination of Benefits, the following language to the end of the paragraph:
 
      AHCCCS has developed a process and agreement with Blue Cross Blue Shield of Arizona (BCBSAZ) to receive both historic and current BCBSAZ coverage data.
 
      Based on this information, AHCCCS will be submitting claims on behalf of AHCCCS Contractors for services reimbursed for dates of services 1/15/06 through 3/31/08. From the monies recovered, AHCCCS will disburse 50% to the Contractor and 50% to the Agency for recoveries of non-TWG, non-PPC, non-Reinsurance related claims. For these claims, AHCCCS will withhold 12% of the disbursement to the Contractor to compensate the vendor recovering the funds. AHCCCS will retain 100% of any BCBSAZ recoveries related to PPC, TWG and Reinsurance-related claims. The Contractor is restricted from recouping any funds for BCBSAZ liability for the period of 1/15/06- 3/31/08. However, the Contractor is responsible for coordination of benefits from 4/1/08 forward.
By signing this contract, the Contractor is agreeing to the terms of the contract.
     
NOTE: Please sign and date all copies and then return one executed original to:
   Mark Held
 
   Sr. Procurement Specialist
 
   AHCCCS Contracts
 
   701 E. Jefferson St., 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. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
 
10. SIGNATURE OF AHCCCSA CONTRACTING OFFICER:
 
    
/s/ Carolyn Rose
  /s/ Michael Veit
     
TYPED NAME: CAROLYN ROSE
  MICHAEL VEIT
TITLE: CHIEF EXECUTIVE OFFICER
  CONTRACTS & PURCHASING ADMINISTRATOR
DATE: 1-20-2009
  DATE: 1/12/2009