IASIS Healthcare LLC - FORM 10-K - EX-10.11 - EXHIBIT 10.11 - November 25, 2009

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10-K - FORM 10-K - IASIS Healthcare LLCc92860e10vk.htm
EX-10.15 - EXHIBIT 10.15 - IASIS Healthcare LLCc92860exv10w15.htm
EX-10.13 - EXHIBIT 10.13 - IASIS Healthcare LLCc92860exv10w13.htm
EX-10.16 - EXHIBIT 10.16 - IASIS Healthcare LLCc92860exv10w16.htm
EX-10.17 - EXHIBIT 10.17 - IASIS Healthcare LLCc92860exv10w17.htm
EX-10.12 - EXHIBIT 10.12 - IASIS Healthcare LLCc92860exv10w12.htm
EX-21 - EXHIBIT 21 - IASIS Healthcare LLCc92860exv21.htm
EX-31.2 - EXHIBIT 31.2 - IASIS Healthcare LLCc92860exv31w2.htm
EX-31.1 - EXHIBIT 31.1 - IASIS Healthcare LLCc92860exv31w1.htm
EX-10.18 - EXHIBIT 10.18 - IASIS Healthcare LLCc92860exv10w18.htm
EX-10.14 - EXHIBIT 10.14 - IASIS Healthcare LLCc92860exv10w14.htm
Exhibit 10.11
     
(AHCCCS LOGO)
  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

 

 

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