Contract Amendment Number 11, executed on September 7, 2005, but effective as of September 1, 2005, to the Arizona Health Care Cost Containment System Administration Contract No. YH04-0001-06 between VHS Phoenix Health Plan and the Arizona Health Care Cost Containment System
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EX-10.5 3 exhibit10_5.txt EXHIBIT 10.5 ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A. CONTRACT AMENDMENT 1. AMENDMENT NUMBER: 11 2. CONTRACT NO.: YH04-0001-06 3. EFFECTIVE DATE OF AMENDMENT: September 1, 2005 4. PROGRAM: DHCM 5. CONTRACTOR'S NAME AND ADDRESS: Phoenix Health Plan/Community Connection 7878 N. 16th Street Phoenix, Arizona 85020 6. PURPOSE OF AMENDMENT: 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 one original to: Gary L. Callahan, Contract Management Supervisor AHCCCS Contracts and Purchasing 701 E. Jefferson Street 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: PHOENIX HEALTH PLAN SIGNATURE OF AUTHORIZED INDIVIDUAL: /s/NANCY NOVICK TITLE: CHIEF EXECUTIVE OFFICER DATE: 9/7/05 10. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM SIGNATURE: /s/MICHAEL VIET TITLE: CONTRACTS & PURCHASING ADMINISTRATOR DATE: 9/6/05
