HomeMy WebLinkAboutKitsap Physicians Service 092093 1_0214, : 1,/ ,alth. -e3.,_.3
SEP 21993
KITSAP PHYSICIANS SERVICE
PARTICIPATING HEALTH DEPARTMENT AGREEMENT
THIS AGREEMENT is made and entered into between KITSAP PHYSICIANS SERVICE
("KPS"), a health care service contractor licensed by the State of Washington, and the undersigned
health department ("HEALTH DEPT").
eb nam and en m t e o taming
contracts for the furnishing of professional services to an ' group with which KPS shall r,,iH
contract, and the HEALTH DEPT a r y to furnish such medical services as are provided
in such contracts whi as made or shall make. The HEALTH DEPT shall at all times have the
HEALTH DEPT agrees to bill KPS its usual, customary, and reasonable fee for all covered
services, and to accept the KPS Maximum Allowance as payment in full.
HEALTH DEPT agrees to abide by the Articles of Incorporation and the Bylaws of KPS, the
policies, rules and regulations established by the Board of Directors of KPS.
HEALTH DEPT hereby agrees that in no event, including, but not limited to nonpayment by
KPS, KPS's insolvency or breach of this contract shall HEALTH DEPT bill, charge, collect a deposit
from, seek compensation, remuneration or reimbursement from, or have any recourse against an
enrolled participant or person, other than KPS, acting on their behalf, for services provided pursuant
to this contract. This provision shall not prohibit collection of deductibles, copayments, coinsurance,
and/or noncovered services, which have not otherwise been paid by a primary or secondary carrier in
accordance with regulatory standards for coordination of benefits, from enrolled participants in
accordance with the terms of the enrolled participant's subscriber agreement.
HEALTH DEPT agrees, in the event of KPS's insolvency, to continue to provide the services
promised in this contract to enrolled participants of KPS for the duration of the period for which
premiums on behalf of the enrolled participant were paid to KPS or until the enrolled participant's
discharge from inpatient facilities, whichever time is greater.
Notwithstanding any other provision of this contract, nothing in this contract shall be construed
to modify the rights and benefits contained in the enrolled participant's subscriber agreement.
HEALTH DEPT may not bill the enrolled participant for covered services, except for
deductibles, copayments or coinsurance, where KPS denies payments because the HEALTH DEPT has
failed to comply with the terms of the Participating Health Department Agreement.
HEALTH DEPT further agrees (i) the immediately preceding four paragraphs of this agreement
shall survive termination of this agreement regardless of the cause giving rise to termination and shall
be construed to be for the benefit of KPS's enrolled participants, and (ii) that this provision supersedes
any oral or written contrary agreement now existing or hereafter entered into between KPS and enrolled
participants or persons acting on their behalf.
If HEALTH DEPT contracts with other health care providers who agree to provide covered
services to enrolled participants of KPS with the expectation of receiving payment directly or indirectly
from KPS, such providers must agree to abide by the immediately preceding five paragraphs of this
agreement.
KPS PROV-0492 (HEALTH DEPT)
This Agreement supersedes any and all other Participating Agreements previously entered into
betweem KPS and HEALTH DEPT.
This Agreement shall be subject to cancellation upon 30 days written notice by either party.
Dated this day of ._Q f .�e444. , 19 7a
1
KITSAP S ERVIC JE SON COUNTY HEALTH DEPT
J - %ric,
By:
• nature - Administrat i 7
Title:PRES T DENT Name: `-a471) D - c ' C �71
(Typed or printed)
Address: Castle Hill Ctr, 615 Sheridan
Port Townsend, Washington 98368-2439
JEFFERSON COUNTY
BOARD OF COMMISSIONERS
Tax ID No.:
BY: / 4 /
Phone:
WFL*:
Medicare #:
UPIN #:
DEA #:
KPS Provider No:
(Assigned by KPS)
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KPS PROV-0492 (HEALTH DEPT)