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

C&@)RONIS HEALTH Workers Compensation Coronis Health has Workers’ Compensation and Employees’ Liability Insurance that is in accordance with New Jersey Law. 40

C@RONIS —— HEALTH Statement of Professional Practice Coronis Health the Company nor any individuals assigned to this engagement are disbarred, suspended, or otherwise prohibited from performing professional practice by any Federal, State, or local agency specifically the Medicare and Medicaid programs. 41

CG@)RONIS —— HEALTH Description of Office Location: Coronis Health’s’ office is located at 50 Route 9 North Bldg. B Morganville NJ. In the beginning of 2011 Coronis Health (previously known as Revenue Guard) upgraded operations and now operate out of a 10,000 square foot state- of- the- art secure finance/billing center located at 50 Route 9 North Morganville, NJ 07751 which is approximately 36 miles from the Township of West Orange. For our customers’ convenience, we have over 20 phone lines and our calls are answered in under 2 minutes. Our toll-free number is (866) 624-0900 and fax is (732) 640-1138. This new center has allowed Coronis Health the physical space to match the unparalleled growth we have earned during the past few years. Our staff is comprised of over 60 employees, 5 managers and 3 supervisors holding full time status in order to handle the demands of our customers and meet their unique needs and concerns. Coronis Health’s’ Executive team and staff members will be and are available for meetings, conferences, training, and other emergency response at either our facility or at the Township of West Orange facilities upon request. 42

C@RONIS HEALTH Statement _and Representation that all Services are performed in the United States: Coronis Health represents that all our services to be performed as part of this RFP will be performed within the United States of America. 43

Statement to Comply with General Terms and Conditions: Coronis Health agrees to comply with all the General Terms and Conditions required by the Township of West Orange and agrees to enter into the Township of West Orange Standard of Professional Services Contract. 44

C@&RONIS —_— HEALTH Certification Statement Coronis Health is providing assurance with a certification statement that we are committed to complying with the Standards for Privacy or Individually Identifiable Health Information (the Privacy Rule) under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and has developed and implemented internal practices, books, and records relating to the use and disclosure of Protected Health. 45

C&RONI HEALTH Lawsuit Statement Coronis Health has no past or present lawsuits filed against our firm. S 46

State of New Jersey DEPARTMENT OF BANKING AND INSURANCE CERTIFICATION AS A QUALIFIED THIRD-PARTY BILLING SERVICE Trenton, NJ August 17, 2021 I, Marlene Caride, Commissioner of Banking and Insurance of the State of New Jersey, do hereby certify that Coronis Health RCM, LLC Certification # 515025836 has complied with all the requirements of N.J.S.A. 17B:27B-1 of the “Revised Statutes” of this State with respect to operating as a third-party billing service and is duly authorized to operate as such in this State on and after August 17, 2021 unless and until such authority is suspended or revoked pursuant to N.J.S.A. 17B:27B-5. IN TESTIMONY WHEREOBF, I have hereunto set my hand and affixed my Official Seal, at Trenton, NJ, the day and year above written. Fe | Marlene Caride Commissioner of Banking and Insurance Visit us on the Web at www.njdobi.org New Jersey is an Equal Opportunity Employer ¢ Printed on Recycled Paper and Recyclable

STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE Taxpayer Name: Trade Name: Address: Certificate Number: Effective Date: Date of Issuance: CORONIS HEALTH RCM, LLC 5963 EXCHANGE DRIVE STE 114 SYKESVILLE, MD 21784 2600268 June 21, 2021 June 23, 2021 For Office Use Only: 20210623120113972

rom W=9 Request for Taxpayer oo. Give Form to the (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury 7 . send to the IRS. Intemal Revenue Service > Go to www.irs.gov/FormW/9 for structions and the latest information. 1 Name (as shown on your Income tax return). Names required on this line; do not leave this line blank, Coconis [Health LLC 2 Business name/disregarded entity name, if different from above Coronts Wealthy BCax, LLC ‘8 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the | 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; Instructions on page 3): tncividuavsole proprietor or ©] c Corporation CO trustiestate ‘single-member LLC. O scorporation [1 Partnership Exempt payee coda (it any) [Limited iaitty company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)>_° Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check | Exemption from FATCA reporting LLC Ifthe LLCs classified as a single-member LLC that is disregarded from the owner unless the owner of the LLGIS | cous Gf any) another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLG that| {s disregarded from the owner should check the appropriate box for the tax classification of Its owner. 1 Other (see Instructions) > 5 Address (number, street, and apt. or suite no) See Instructions, 5963 Exchanne Drive, Ste 4 6 City, state, and ZIP code Sukesvile , MO APY 7 List eeéount number(s) here (optional) ‘Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avold backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole propriotor, or disregarded entity, see the instructions for Part I, later. For other - - entitles, it Ts your employer identification number EIN), I you do not have a number, see How to get a y, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Part Il Certification Under penalties of