Terms of Service

This is an agreement between You, the Customer identified in the signature block of the Appendix II of the Master Services Agreement (hereinafter referred to as “Customer” or “Licensee”), and Opus Health Inc. (hereinafter referred to as “OPUS” or “Licensor”). This document describes and defines the services to be provided to the Customer should Customer choose to contract with OPUS and its partner, SAIcle One Solutions, LLC (hereinafter referred to as "SAI") through the Master Subscription Agreement. It also describes and defines the roles, restrictions, penalties, and other terms that Licensor agrees to abide by during, and sometimes after, the Term provided in Customer’s Master Subscription Agreement.

1. Scope of Work:
   SAI will be the exclusive provider of payor enrollment services and will apply its best efforts to credential Customer’s providers on behalf of Customer for top fifteen (15) payors, to be defined by mutual agreement of the parties on a state-by-state basis (and additional payors at Customer request) beginning on or after the Effective Date, in accordance with the provisions of the Scope of Work outlined below (Services).
   
   In-Scope Services:
    
   1. Creation of a customized enrollment checklist and welcome packet that addresses provider specific and state specific information collection.
   2. Collection of complete and accurate individual provider/group credentialing information in a format required by SAI.
   3. Develop projected timeline for group and provider enrollment with each payor.
   4. Initial provider enrollment with Top 15 required payors (Medicare, Medicaid, commercial plans).
   5. Verification of provider’s participation status with payors prior to credentialing submission.
   6. Completion of credentialing application and collection of required signatures for initial enrollment
   7. Quality assurance process to ensure applications are submitted correctly.
   8. CAQH completion and validation for commercial insurance enrollment.
   9. Application submission tracking and reporting to Customer
   10. Phone and email support as well as regularly scheduled reviews with Customer on application progress through planned calls and reporting
   11. Coordination with Customer administration to follow up with providers for the purposes of obtaining providers’ physical signatures on paper applications and collecting information.
   12. Payor credentialing
       
       • Verification of each provider’s current participation status with all payors prior to credentialing submission accomplished through Medicare portal, Medicaid portal, CAQH review or direct with the payor
       • Initiation and completion of credentialing applications for initial enrollment and provider re-enrollment, as necessary.
       • CAQH enrollment, follow up, completion, and validation for payors as requested by Customer.
       • Follow up with payors once Customer administration receives certified receipts for paper applications.
       • Initiation and completion of NPI registration and enrollment with PECOS, as required by Customer.
   13. Application submission via paper submission, online portal (PECOS, etc.), mail, or fax.
   14. Email and SFTP support for Customer administration.
   
   Out of Scope Services:
   
   
   1. Payor contract and fee schedule negotiation are out of scope for this project but can be considered and priced under a separate statement of work.
   2. Payor enrollment application custom reporting requests will be quoted and priced separately.
   3. Group enrollment with federal, state, and commercial payors may be completed as requested by the Customer and will be billed at the hourly rate structure identified below.
   4. Facilities and hospital privileging are out of scope.
2. Customer Responsibilities:
   
   
   1. Provide the required documentation to SAI needed to perform the Services. Provide SAI with complete provider/ service location information sheet for each provider, as well as any additional information needed for credentialing in a format acceptable to SAI. Failure to provide accurate provider/ service location information may have a cash impact.
   2. Customer will select the top 15 payors which providers are to be enrolled with. SAI will only proceed with enrollment for the payors which Customer selects. SAI is to be advised in writing if Customer changes selection.
   3. Provide SAI with the date of hire for all providers/service locations and provide a minimum of twenty-two (22) business days’ notice prior to the first service date of the provider being credentialed to avoid cash impact. This information is to be reported in a format acceptable to SAI.
   4. Customer administrator is responsible for obtaining documents and other supporting information, including provider signatures on paper applications and certified receipts for paper applications, required to process credentialing.
   5. Customer agrees that all insurance enrollment to be filed on behalf of providers will be handled exclusively by SAI.
   6. Customer is responsible for notifying SAI each month of providers who have been terminated or left the practice.  A determination will be made if any open credentialing activities should continue.

1. Additional Terms and Conditions:
   
   
   1. SAI reserves the right to update its pricing and rates for services at the renewal of each term.
   2. Travel Expenses incurred during the implementation and onboarding period will be billed monthly to the Customer at cost.
   3. Key Contact.  The Key Contact(s) shall be deemed the agent(s) of Customer for the purpose of communications and consents between the Parties under this Agreement. In particular, the Key Contact(s) shall have the power to agree, on behalf of the Customer, to resolutions of issues arising under the Agreement and, at SAI’s request, to receive confirmation memoranda or letters. In addition, the Key Contact(s) will respond to inquiry or request from SAI in three (3) business days prior to such change.
   
   This version of this Terms of Service has been effective and updated on this website since November 30, 2023, at 11:42 AM ET. This Terms of Service supersedes previous Terms of Service posted on this site.