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EMS Billing Services <br />City of La Porte RFP #20510 <br />Table ofContents <br />1. Cover Letter...................................................................................................................................2 <br />2. Firm Background and Experience of Staff..................................................................................5 <br />3. Ability to Perform Required Services..........................................................................................8 <br />Ambulance Billing........................................................................................................................11 <br />Billing and Collection Procedure..................................................................................................11 <br />Collection Services......................................................................................................................13 <br />4. Implementation Schedule...........................................................................................................55 <br />5. References...................................................................................................................................56 <br />6. Fees/Pricing.................................................................................................................................58 <br />7. Concluding Remarks..................................................................................................................59 <br />8. Samples.......................................................................................................................................59 <br />Required Submittals.......................................................................................................................66 <br />Bid Execution by a Corporation....................................................................................................66 <br />Acknowledgement Form..............................................................................................................66 <br />Conflict of Interest Questionnaire.................................................................................................66 <br />Form 1295 Certificate of Interest Parties......................................................................................66 <br />House Bill 89 Verification Form....................................................................................................66 <br />General Standard Terms & Conditions.........................................................................................66 <br />Certificate of Liability Insurance...................................................................................................66 <br />Current SSAE 16 Type II Audit Documentation............................................................................66 <br />CMS Audit....................................................................................................................................66 <br />4 <br />Confidential & Proprietary <br /> <br />