318-22 Exhibit A-Coronis Health for Emergency Transport Third Party Billing - 2022.pdf

TOWNSHIP OF WEST ORANGE insured coverage and shall name the TOWNSHIP as an additional insured. 3. Indemnification. Successful vendor shall indemnify and hold harmless the TOWNSHIP from all claims, suits or actions and damages or costs of every name and description to which the TOWNSHIP may be subjected or put by reason of injury to the person or property of another, or the property of the TOWNSHIP, resulting from negligent acts or omissions on the part of the vendor, the vendor's agents, servants or subcontractors in the delivery of goods and services, or in the performance of the work under the contract. V. STATUTORY AND OTHER REQUIREMENTS. The following are mandatory requirements of this proposal and contract. 1. Mandatory Affirmative Action Certification. No firm may be issued a contract unless it complies with the affirmative action provisions of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1 et seq. The following information summarizes the full, required regulatory text, which is included as Exhibit A of this proposal specification. Goods and Services (including professional services) Contracts: Each contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: a. A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned Affirmative Action program (good for one year from the date of the letter), or b. A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; or c. A photocopy of an Employee Information Report (Form AA302) provided by the State of New Jersey, Division of Contract Compliance & Equal Employment Opportunity and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. 3. Stockholder Disclosure. Vendors shall submit a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners

a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10) percent or more of its stock of any class, or of all individual partners in the partnership who own a ten percent or greater interest therein. The included Statement of Stockholder Disclosure shall be completed and attached to the bid. This requirement applies to all forms of corporations and partnerships, including, but not limited to, limited partnerships, limited liability partnerships and Subchapter S corporations. Failure to submit a stockholder disclosure document shall result in rejection of the proposal. 7

TOWNSHIP OF WEST ORANGE 4. Proof of Business Registration. N.J.S.A. 52:32-44 requires that each vendor (contractor) submit proof of business registration with the proposal. Proof of registration shall be a copy of the vendor's Business Registration Certificate (BRC). A BRC is obtained from the State of New Jersey, Division of Revenue. Information on obtaining a BRC is available on the internet at: www.state.nj.us/treasury/revenue/gettingregistered.htm#busentity or call the Division of Revenue at (609) 292-1730. N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract: a. The contractor shall provide written notice to its subcontractors and suppliers to submit proof of business registration to the contractor; b. Prior to receipt of final payment from a contracting agency, a contractor must submit to the contacting agency an accurate list of all subcontractors or attest that none was used; c. During the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all subcontractors and their affiliates that they must collect and remit to the Director, New Jersey Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A. 54:32B-1 et seq.) on all sales of tangible personal property delivered into this State. A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed $50,000 for each business registration not properly provided or maintained under a contract with a contracting agency. Information on the law and its requirements is available by calling (609) 292-1730. 5. Non-Collusion Affidavit The Affidavit shall be properly executed and submitted with the proposal. 6. Iranian Disclosure 7. Receipt of addenda 8. Township Political Contribution Statement - 8

TOWNSHIP OF WEST ORANGE VI. METHOD OF EVAUTION The Township may establish an evaluation committee to evaluate and score the proposals submitted by the vendors. Evaluation Criteria: The contract will be awarded to the vendor that best meets the Township’s needs. The following criteria shall be used for evaluating the proposals under the Competitive Contracting process: A. Technical Criteria – Evidence software is compliant with all applicable State of New Jersey and Federal regulations and laws. Evidence of capacity to provide the services within time frame proposed by the Township. B. Management Criteria – Vendor’s prior experience reflect the type of services required under this RFP. Qualifications of vendor’s staff to effectively perform the services required under this RFP. Vendor’s references. Do the vendor’s references provide positive testimony regarding the success of the vendor in collecting outstanding debts and obligations? Information vendor provides detailing information concerning workflow and turnaround time from initial receipt of data to receipt of payment? History of vendor’s percentage of collection in terms of dollars and claims? Does vendor meet experience requirements stipulated in this RFP? C. Cost Criteria – 9

TOWNSHIP OF WEST ORANGE Does the vendor’s cost proposal provide the best economic advantage to the Township? VII. TERMINATION OF CONTRACT 1. If, though any cause, the successful vendor shall fail to fulfill in a timely and proper manner obligations under this contract or if the contractor shall violate any of the requirements of the notice to the contractor of such termination and specifying the effective date of termination. Such termination shall relieve the Township of any obligation for balances to the contractor of any sum or sums set forth in the contract. Township will pay only for goods and services accepted prior to termination. 2. Notwithstanding the above, the contractor shall not be relieved of liability to the TOWNSHIP for damages sustained by the TOWNSHIP by virtue of any breach of the contract by the contractor and the TOWNSHIP may withhold any payments to the contractor for the purpose of compensation until such time as the exact amount of the damage due the TOWNSHIP from the contractor is determined. 3. The contractor agrees to indemnify and hold the TOWNSHIP harmless from any liability to subcontractors/suppliers concerning payment for work performed or goods supplied arising out of the lawful termination of the contract by the TOWNSHIP under this provision. 4. In case of default by the successful vendor, the TOWNSHIP may procure the goods and services from other sources and hold the successful vendor responsible for any excess cost. 5. Continuation of the terms of this contract beyond the fiscal year is contingent on availability of funds in the following year's budget. In the event of unavailability of such funds, the TOWNSHIP reserves the right to cancel this contract. 6. ACQUISITION, MERGER, SALE AND/OR TRANSFER OF BUSINESS, ETC. It is understood by all parties that if, during the life of the contract, the contractor disposes of his/her business concern by acquisition, merger, sale and/or transfer or by any means convey his/her interest(s) to another party, all obligations are transferred to that new party. In this event, the new Township(s) will be required to submit all documentation/legal instruments that were required in the original proposal/contract. Any change shall be approved by the TOWNSHIP.

ent, the new Township(s) will be required to submit all documentation/legal instruments that were required in the original proposal/contract. Any change shall be approved by the TOWNSHIP. 7. The contractor will not assign any interest in the contract and shall not transfer any interest in the same without the prior written consent of the TOWNSHIP. III. PAYMENT 1. No payment will be made unless duly authorized by the TOWNSHIP'S authorized representative and accompanied by proper documentation. 2. Payment will be made in accordance with the TOWNSHIP'S policy and procedures. 10

TOWNSHIP OF WEST ORANGE IX. CONTRACT TERM This contract shall begin following date of award thirty-six (36) months. The Township reserves the right to renew this contract for an additional two years not too exceed five (5) years. Renewal shall be enacted by the recommendation of Business Administrator with the approval of the West Orange Township. The TOWNSHIP'S representative shall provide a written intent to extend the agreement. The same conditions shall prevail. The price (if applicable) shall only be adjusted as per the State established index rate. Any contract resulting from this proposal shall be subject to the availability and appropriation of sufficient funds annually. The Township of West Orange may, at any time during the contract period, terminate the contract by giving thirty (30) days’ notice in writing to the Vendor. 11

TOWNSHIP OF WEST ORANGE SCOPE These specifications outline the requirements for a vendor to provide private patient billing services for people transported by either the West Orange Fire Department “WOFD”. The WOFD is the primary Basic Life Support (BLS) provider for the Township. WOFD responds to over 4700 BLS incidents annually. WOFD also respond to (and transport) ALS (advanced life support) calls with paramedics. The Township is only interested in obtaining payment from the user’s insurance company. We do not seek co-pays or deductibles from the township residents’ who are transported. The Township will not charge a resident that is not covered by insurance. It is the Township’s intention not to be involved with any of the day to day billing and collection process. The proposal package consists of three parts: 1) General Conditions for submission 2) Technical requirements and 3) Proposal Documents & Checklist. These specifications may not contain all of the processes or requirements necessary to accomplish third party billing. Each vendor should provide those services which, in their opinion, are required to provide a complete billing service for the Township of West Orange thereby fulfilling the intent of these specifications. If any of the requirements contained in these specifications is contrary to standard procedures for third party billing services, the vendor must seek a clarification from the Township or should proposal the specifications as written and file a letter stating their reservations over any unusual requirements. 12

TOWNSHIP OF WEST ORANGE SPECIFICATIONS Township Responsibilities Once a vendor has been selected, a Township representative will be assigned by the WOFD. The Township shall supply to the vendor a completed ambulance incident report within 5 calendar days of the provision of ambulance services. The Township, in cooperation with the selected vendor, shall open the necessary bank account at a bank convenient to the vendor. This account shall be a "lock box" concept wherein all funds are credited to the Township and can only be withdrawn by the Township. Vendor Responsibilities 1. Vendor shall supply Township with patient Care forms that will be utilized by all Emergency Medical Service personnel. These forms shall comply with all Federal and State Statutes, regulations, and guidelines. 2. Vendor shall supply at no cost to Township, four (4) laptops with touch screen capabilities or tablets per Basic Life Support Unit, plus one spare. Each laptop or tablet shall be tested and certified to mil-standard 810g and IP65. The vehicle mounts must be State of New Jersey, Division of Health and Senior Services (to be referred to as DOHSS) approved for the life of the contract. Laptops provided by vendor need to be identical and equipped with an integrated air cards and with data service provided by vendor. Vendor shall provide all technical support necessary to ensure the laptops and ePCR are working and shall ensure within 24 hours a replacement laptop is provided if needed. a. Vendor will supply four (4) classroom training sessions annually to cover EMS report writing, laptop use, ePCR software usage and a chart/narrative writing annually while under contract. b. Vendor shall supply Township with Patient Care forms to be utilized by all EMS personnel in the event internet outages. 13

TOWNSHIP OF WEST ORANGE 3. Vendor will be responsible for all costs for related to software such as EMScharts. If EMS charts becomes unable to provide ePCR services, it will be the vendors’ responsibility to supply another ePCR software package that the Township approves at no additional cost. 4. Vendor shall review Patient Care Forms within 5 working days of receipt. After review, the forms are either processed for billing the appropriate insurance provider or returned to WOFD for further information or clarification. The vendor shall provide the WOFD with a monthly quality assurance report indicating the status and quality of the ePCRs being completed by WOFD crews. a. The initial billing shall be sent to the insurance provider, with an advice copy to the patient. If the insurance provider name or address is not obtained at the time of the service, vendor shall obtain this information by any means necessary, other than the patient. The vendor is responsible for maintaining accurate information concerning the claim processing address and procedures for all insurance providers licensed to do business in New Jersey. The vendor will not invoice a ‘resident’ patient who does not have coverage” since we do bill non-residents without coverage. 5. The Township shall retain the rights to all records and reports that are utilized and generated in connection with the execution of this contract. a. No records and/or reports shall be released without the prior written approval of the Business Administrator. b. All records shall be maintained in accordance with the prescribed N.J. State Statutes pertaining to Record Retention and for a period not less than six (6) years. No records shall be disposed of, without first obtaining approvals from the Township. c. Vendor shall be required to provide the following services to the Township on a monthly basis: d. All pertinent records shall be sent to the Township monthly e. This service shall include the removal of staples, scanning and shredding of all documents after the prescribed time period as stipulated in the N.J. State Statues pertaining to