HomeMy WebLinkAboutCity of Tamarac Resolution R-2003-223u
1
1
Temp. Reso. #10224
August 14, 2003
Revised September 15, 2003
Revised September 17, 2003
Page 1
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2003- A 5
A RESOLUTION OF THE CITY COMMISSION
OF THE CITY OF TAMARAC, FLORIDA
AUTHORIZING THE APPROPRIATE CITY
OFFICIALS TO EXECUTE AN AGREEMENT
AMENDMENT BETWEEN THE CITY OF
TAMARAC AND ADVANCED DATA
PROCESSING, INC., A DELAWARE
CORPORATION RENEWING THE
AGREEMENT FOR MEDICAL BILLING
SERVICES AND AMENDING SAID
AGREEMENT TO PROVIDE FOR HEALTH
INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT NOTICE
REQUIREMENTS, EFFECTIVE OCTOBER 1,
2003 THROUGH SEPTEMBER 30, 2004,
PROVIDING FOR CONFLICTS; PROVIDING
FOR SEVERABILITY; AND PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS, the City of Tamarac awarded RFP 99-17R and entered into an
Agreement with Advanced Data Processing, Inc., a Florida Corporation, now known as
Advanced Data Processing, Inc., a Delaware Corporation, for the provision of medical
billing services, on September 22, 1999 by resolution R99-239, a copy of said resolution
and Agreement is attached hereto as Exhibit "A"; and
Temp. Reso. #10224
August 14, 2003
Revised September 15, 2003
Revised September 17, 2003
Page 2
WHEREAS, the Agreement allows for two (2) additional one (1) year renewals; and
WHEREAS, the Agreement was renewed for the first additional one (1) year period
from October 1, 2002 through September 30, 2003 by resolution R2002-255 attached
hereto as Exhibit "B"; and
WHEREAS, this is the second and final one (1) year renewal option for October 1,
2003 through September 30, 2004; and
WHEREAS, the City of Tamarac and Advanced Data Processing, Inc. a Delaware
Corporation are required to comply with the Health Insurance Portability and Accountability
Act (HIPAA); and
WHEREAS, Advanced Data Processing, Inc. a Delaware Corporation has agreed to
notify each patient transported by Tamarac Fire Rescue of their rights as required by
HIPPA; and
WHEREAS, the cost to the City for the additional service by Advanced Data
Processing, Inc., a Delaware Corporation to provide HIPAA notification to each transported
patient shall be $1.00 per transport, not to exceed five hundred dollars ($500.00) per
month; and
WHEREAS, Advanced Data Processing, Inc. a Delaware corporation has agreed to
amend and renew the Agreement, a copy of said amendment and is attached hereto as
Exhibit C; and
WHEREAS, it is the recommendation of the Fire Chief and the Purchasing and
Contracts Manager that the City exercise the second renewal option of the Agreement
Temp. Reso. #10224
August 14, 2003
Revised September 15, 2003
Revised September 17, 2003
Page 3
between the City of Tamarac and Advanced Data Processing, Inc., a Delaware
Corporation, and amend said Agreement to provide for HIPAA notice requirements for a
one-year term effective October 1, 2003 through September 30, 2004; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in
the best interest of the citizens and residents to execute the renewal of the Agreement
between the City of Tamarac and Advanced Data Processing, Inc., for the provision of
medical billing services with Advanced Data Processing, Inc. a Delaware Corporation, and
amend said Agreement to provide for HIPAA notice requirements for a one-year term
effective October 1, 2003 through September 30, 2004.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed
as being true and correct and are hereby made a specific part of this Resolution upon
adoption hereof.
SECTION 2: The Agreement Amendment between the City of Tamarac and
Advanced Data Processing, Inc. a Delaware Corporation renewing the Agreement for the
provision of medical billing services and amending the Agreement in order to provide for
HIPAA notice requirements is hereby approved for the term October 1, 2003 through
September 30, 2004.
SECTION 3: All resolutions or parts of resolutions in conflict herewith are HEREBY
repealed to the extent of such conflict.
Temp. Reso. #10224
August 14, 2003
Revised September 15, 2003
Revised September 17, 2003
Page 4
SECTION 4: If any clause, section, other part or application of this Resolution is
held by any court of competent jurisdiction to be unconstitutional or invalid, in part or
application, it shall not affect the validity of the remaining portions or applications of this
Resolution.
SECTION 5: This Resolution shall become effective immediately upon its passage
and adoption.
PASSED, ADOPTED AND APPROVED this 24th day of September, 2003.
d E SCHREIBER
ayor
ATTEST:
RECORD OF COMMISSION VOTE:
MARION SWEN ON, CMC MAYOR SCHREIBER i
CITY CLERK DIST 1: COMM. PORTNER
DIST 2: COMM. FLANSBAUM-TALABI
DIST 3: COMM. SULTANOF
DIST 4: V/M ROBERTS
I HEREBY CERTIFY that
have approved this
RESOLUTION as to form
MITC-HELL S!-KF
CITY ATTORN
A
Temp. Re so . # 10 2 2 4 Temp. Reso. #8749
EXHIBIT A September 1, 1999
Pagel
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-99- tic V
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA AUTHORIZING THE AWARD OF
RFP 99-17R ENTITLED "MEDICAL BILLING SERVICES" TO
ADVANCED DATA PROCESSING, INC.; PROVIDING FOR
CONFLICTS; PROVIDING FOR SEVERABILITY; AND
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the Fire Department is required to provide life support services to the
citizens and visitors of the City of Tamarac and bill patients for these medical services; and
WHEREAS, The City of Tamarac publicly advertised RFP 99-17R entitled "Medical
Billing Services" in the Sun -Sentinel on May 9th and May 16th, 1999; and
WHEREAS, Proposals were solicited from (10) vendors and six (6) proposals were
received and evaluated by the Evaluation Committee consisting of the Assistant Fire Chief,
Firefighter, Controller, Social Services Coordinator and Senior Buyer to determine
responsiveness to the City's specifications and two proposers were requested to make
presentations; and
WHEREAS, Advanced Data Processing, Inc. was determined to be the most
responsive, responsible proposer as per the tabulation attached hereto as Exhibit "A"; and
Temp. Reso. #8749
September 1, 1999
Page 2
WHEREAS, The term of RFP 99-17R is for the period beginning October 1, 1999
through September 30, 2002 with the ability to extend the award for two subsequent one
year periods, not to exceed a total award period of five (5) years; and
WHEREAS, it is the recommendation of the Fire Chief and Purchasing and
Contracts Manager that the billing of patients transported by the City of Tamarac Fire
Department be awarded to Advanced Data Processing, Inc.; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in
the best interest of the citizens and residents to authorize the award of RFP 99-17R
entitled "Medical Billing Services" to Advanced Data Processing, Inc., for the purpose of
billing patients transported by the City of Tamarac Fire Department.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing 'WHEREAS" clauses are hereby ratified and confirmed
as being true and correct and are hereby made a specific part of this Resolution upon
adoption hereof.
SE TION 2: RFP 99-17R entitled "Medical. Billing Services" is hereby awarded to
Advanced Data Processing, Inc. for the period beginning October 1, 1999 through
September 30, 2002 with the ability to extend the award for two subsequent one year
periods, not to exceed a total award period of five (5) years; and
SECTION 3: All resolutions or parts of resolutions in conflict herewith are HEREBY
1
fl
Temp. Reso. #8749
September 1, 1999
Page 3
repealed to the extent of such conflict.
SECTION 4: If any clause, section, other part or application of this Resolution is
held by any court of competent jurisdiction to be unconstitutional or invalid, in part or
application, it shall not affect the validity of the remaining portions or applications of this
Resolution.
SECTION 5: This Resolution shall become effective immediately upon its passage
and adoption.
PASSED, ADOPTED AND APPROVED this aaday of SP4"Itq�' 1999.
ATTEST:
6(,A�Oor
CAROL GO , CMC/AAE
CITY CLERK--"
I HEREBY CERTIFY that I
ve approved this
REWOLUTION as to foam.
"C.J
MITCHELL S.
City Attorney
w
J6kSCHREIBER
Mayor
RECORD OF COMMISSION
MAYOR
SCHREIBER
DIST 1:
COMM. PORTNER
DIST 2:
V/M MISHKIN
DIST 3:
COMM. SULTANOF
DIST 4:
COMM. ROBERTs_.j
STANDARD FORM OF AGREEMENT
THIS AGREEMENT is entered into onJAt �a,1999, between the City of
Tamarac, a municipal corporation with principal offices located at 7525 NW 881h
Avenue, Tamarac, Florida 33321 (hereinafter "City") and, Advanced Data Processing.,
a Florida corporation with principal offices located at, 520 NW 165th Street, Miami,
Florida 33169 (hereinafter "Contractor)
WITNESSETH:
The CITY and the CONTRACTOR in consideration of the mutual covenants
hereinafter set forth, agree as follows:
1. The undersigned CONTRACTOR hereby represents that it has carefully
examined the Proposal Specifications and all Contract documents, and will perform the
contractual requirements pursuant to all covenants and conditions. The
CONTRACTOR agrees to comply with the requirements of the specifications contained
in the Request for Proposal.
2. The CONTRACTOR, as evidenced by the execution of this contract,
acknowledges that it has examined the physical characteristics of the job requirements.
The CONTRACTOR further acknowledges that the proposal price of a Flat Fee
Percentage of 7.00% to administer billing and collections and Flat Rate of $150.00 per
month for Medicaid, includes all costs and expenses and is the total compensation required to
be paid by the CITY for the satisfactory completion of the contract requirements.
3. The contract between the CITY and the CONTRACTOR include the
following documents which are attached hereto and incorporated herein by reference of
the following:
CONTRACT DOCUMENTIS
Request for Proposal, Instructions to Bidders,
General Terms and Conditions,
Insurance Requirements, Special Conditions
Specifications
Proposal Form
Proposal Signature Form
Statement of No Bid
Variations
Certification
Proposer's Qualification Statement
References
Drug Free Workplace Certification
Addenda numbers 1 to �inclusive, and
Any Modifications, including Change Orders, duly delivered after execution of this
Agreement.
4. This Agreement shall be for a term of three (3) years beginning on October 1, 1999
and ending on September 30, 2002, and may be renewed in writing for two (2) additional one
(1) year terms.
5. Whenever either party desires or is required under this Agreement to give
notice to any other party, it must be given by written notice, sent by registered
United States mail, with return receipt requested, addressed to the party for
whom it is intended at the following addresses.
Kkl'1
Jeffrey L. Miller
City Manager
City of Tamarac
7525 N.W. 88th Avenue
Tamarac, FL 33321
With a copy to the City Attorney at the same address
CONTRACTOR
Paul J. Franzelas (Name of Contractor)
Vice President (Title of named above)
Adyanced_Data Processing (Name of Company)
520 NW 165` Sty reet� (Address)
Suito. 201 (Address)
Miami, Florida 33169 __(City, State, ZIP)
6. The CONTRACTOR shall not, without prior written consent of the CITY,
assign any portion of its interest under this contract and, specifically, the
CONTRACTOR shall not assign any moneys due or to become due without the prior
written consent of the CITY.
7. CONTRACTOR represents and warrants that the computer system used to cant' out
the obligations set forth in this Agreement ("the System"), and all interfaces to the System,
including, but not limited to, interfaces with other systems and data entry interface for the
System, are Year 2000 compliant. Year 2000 compliant means information technology that
accurately processes date/time data (including, but not limited to, calculating, comparing, and
sequencing) from, into, and between the twentieth and twenty-first centuries and the years 1999
and 2000 and leap year calculations. Year 2000 compliant also means that the Year 2000
compliant information technology, when used in combination with other information technology,
shall accurately process date/time data. when other information technology exchanges datettime
data with it. This warranty shall survive the expiration or termination of this Agreement.
8. CONTRACTOR agrees to indemnify and hold harmless the City of Tamarac, its
elected and appointed officials and employees from any and all claims, suits, actions, damages,
liability, and expenses (including attorneys' fees) including but not limited to, loss of life, bodily
or personal injury, or property damage, and loss of use thereof, directly or indirectly caused by,
resulting from, .arising out of or occurring in connection with the failure of CONTRACTOR's
System to be Year 2000 compliant.
9. The CITY and the CONTRACTOR each binds themselves, their partners,
successors, assigns and legal representatives to the other party hereto in respect to all
covenants, agreements and obligations contained in the contract documents.
10. The contract documents constitute the entire agreement between the
CITY and the CONTRACTOR and may only be altered, amended or repealed by a
• duly executed written instrument.
11. This Agreement shall be governed by the laws of the State of Florida as are now
and hereinafter in force, The venue for actions arising out of this Agreement is fixed in
Broward County, Florida.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, the
day and year first above written.
ATTEST'
Carol Gold, AAE/ C
Cite Clerk
Mitthell S: Ki
City Attorney
WITNESS:
CITY F TAM RAC, FLORIDA
By:
e Schreiber, Mayor
ForB&-7
81 f
Jeffrey LMiWer
City Manager
(Print or Type Name)
(Print or Type Name)
CONTRACTOR:
l
(Print or Type Name and Title)
•
•
0
f� CORPORATE ACKNOWLEDGEMENT
STATE OF
COUNTY OF, G
i
The foregoing instrument was acknowledged before me this day of
S �7 , -�,) - 1999 b I-V L S
Y +) zP� (name of
officer or agent, title of officer or agent) of kku-pNN 0A e_ tic� ,
(name of corporation acknowledging), a LO ILA CA, (state or
place of incorporation) corporation, on behalf of the corporation. He is personally
known to me
identification and did (did not) take an oath.
(type of identification) as
SJOhature of Ncdary Publi State
of Florida
/W//(,- lox Z_
Pripf, Type or Stamp Name of Notary
Public
p1Y P(jB<f CO �s o #Icc 7A92os
EXPIRES FEB 19, 2002
CCd�% IONDEDTHRU
pF �''r4NTIC BONDING CO-, INC-
Temp. Reso. #10224
EXHIBIT B
Temp. Reso. #9$85
August 26, 2002
Pagel
CITY OF TAMARAC, FLORIDA
RESOLUTION NO, R-2002-255
A RESOLUTION OF THE CITY COMMISSION
OF THE CITY OF TAMARAC, FLORIDA
AUTHORIZING THE FIRST RENEWAL OF THE
AGREEMENT BETWEEN THE CITY OF
TAMARAC AND ADVANCED DATA
PROCESSING, INC., FOR MEDICAL BILLING
SERVICES, EFFECTIVE OCTOBER 1, 2002
THROUGH SEPTEMBER 30, 2003,
PROVIDING FOR CONFLICTS; PROVIDING
FOR SEVERABILITY; AND PROVIDING FOR
AN EFFECTIVE ❑ATE.
WHEREAS, the City of Tamarac awarded RFP 99-17R and entered into an
Agreement with Advanced Data Processing, Inc., for the provision of medical billing
services, on September 22, 1999 by resolution R99-239, a copy of said resolution and
Agreement is attached hereto as Exhibit "A"; and
WHEREAS, the Agreement allows for two (2) additional one (1) year renewals; and
WHEREAS, Advanced Data Processing, Inc. has agreed to renew the Agreement
under the same terms and conditions, a copy of said renewal letter is attached hereto as
Exhibit "B"; and
WHEREAS, it is the recommendation of the Fire Chief and Purchasing and
Contracts Manager that the City exercise the first renewal of the Agreement between the
City of Tamarac and Advanced Data Processing, Inc., for a one-year term effective
October 1, 2002 through September 30, 2003; and
Temp, Reso. #9885
August 26, 2002
Page 2
WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in
the best interest of the citizens and residents to authorize the renewal of the Agreement
between the City of Tamarac and Advanced Data Processing, Inc., for the provision of
medical billing services with Advanced Data Processing, Inc. for a one-year term effective
October 1, 2002 through September 30, 2003 with one additional one-year renewal option.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA-
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed
as being true and correct and are hereby made a specific part of this Resolution upon
adoption hereof.
SECTION 2: The Agreement between the City of Tamarac and Advanced Data
Processing, Inc. for the provision of medical billing services is hereby approved for the term
October 1, 2002 through September 30, 2003 with one additional one-year renewal option.
SECTION 3: All resolutions or parts of resolutions in conflict herewith are HEREBY
repealed to the extent of such conflict.
Temp. Reso. #9885
August 26, 2002
Page 3
SECTION 4: If any clause, section, other part or application of this Resolution is
held by any court of competent jurisdiction to be unconstitutional or invalid, in part or
application, it shall not affect the validity of the remaining portions or applications of this
Resolution.
SECTION 5: This Resolution shall become effective immediately upon its passage
and adoption.
PASSED, ADOPTED AND APPROVED this 251h day of September, 2002.
1 ..
J(�E SCHREIBER
Mayor
ATTEST:
RECORD OF COMMISSION VOTE:
MARION SWENSON, CMC MAYOR SCHREIBER AYE
CITY CLERK DIST 1: V/M. PORTNER AYE
DIST 2: COMM. MISHKIN AYE
DIST 3: COMM. SULTANOF AYE
DIST 4: COMM. ROBERTS AYE
I HEREBY CERTIFY that
I have approved this
RESOLUTION as to form.
7Lkw.
MITCHELL 8. KRAFT
CITY ATTORNEY
City of Tamarac Purchasing and Contracts Division
.... .
AGREEMENT AMENDMENT
BETWEEN THE CITY OF TAMARAC
AND ADVANCED DATA PROCESSING, INC.
The CITY OF TAMARAC, a municipal Corporation, with principal offices located at 7525
NW 881" Avenue, Tamarac FL 33321, (City) and Advanced Data Processing, Inc. (ADP), a
Delaware corporation, with principal offices located at 520 NW 165 Street, Suite 201, Miami, FL
33169, agree to amend the original Agreement entered into by the parties dated September 22,
1999 and subsequently renewed on October 1, 2002, as follows:
1. Per the terms of Section 4 of the original Agreement dated September 22, 1999, the City
and ADP exercise the final one-year renewal option for the term October 1, 2003 —
September 30, 2004.
2. Per the terms of the Business Associate Agreement dated July 21, 2003, attached
hereto as Exhibit 1, which addresses compliance with the Health Insurance Portability
and Accountability Act (HIPAA), and in consideration of the costs referenced in the
Order Form for Mailing HIPAA Notice of Privacy Practices, attached hereto as Exhibit 2,
City agrees to pay Contractor an additional sum not to exceed $500.00 per month upon
submission of an approved invoice for this service, submitted on a monthly basis.
3. All other provisions of the original agreement remain in effect as written.
IN WITNESS WHEREOF, the parties hereby have made and executed this Amendment
to Agreement on the respective dates under each signature, the City of Tamarac signing
through its Mayor and City Manager, and Advanced Data Processing, Inc., signing by and
through its President, duly authorized to execute same. '
ATTEST:
14AA,� Lt'?t�
Marion Swenson, CMC
City Clerk
— q )'__9 /0
Date
CITY OF TAM C
J Schreiber, Mayor
Date
Jeffrey L. iller, City Manager
`? S a
Date I If
ApprIved-af toform ang legal syffciency:
Mitchell 4, Igraff, City
Date
----- -------
City of Tamarac
n
Purchasing and Contracts Division
ATTEST. -
(Corporate Secretary)
Type/Print Name of Corporate Secy
(CORPORATE SEAL)
STATE OF FLORIDA
Advanced Data Processing, Inc.
Company Name
Sic5<at&e of President/CEO
Douglas Shamon
Type/Print Name of President/CEO
Date
CORPORATE ACKNOWLEDGEMENT
COUNTY OF gaw'Af' o :SS
I HEREBY CERTIFY that on this day, before me, an Officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared
Douglas Shamon, President/CEO of Advanced Data Processing, Inc., a Delaware
Corporation, to me known to be the person(s) described in and who executed the
foregoing instrument and acknowledged before me that he/she executed the same.
WITNESS my hand and official seal this (�� day of� 2003.
T._
"�t-
gignature of Notary Pu
,��•�,,, Darryr, State of Florida at Large
ti� p5a� pLr /i
�C=m1ss,:= t nD12G61Ka
; P jam'e 17, :*
"� d
„Ss1*J�,'.:ti. 1•w Print, Type or Stamp
Name of Notary Public
Personally known to me or
❑ Produced Identification
Type of I. D. Produced
Ef DID take an oath, or
❑ DID NOT take an oath.
.........................- -- ... ............
City of lawalac � Exhibit 1
Business Associate Agreement
Advanced Data Processing, Inc.
_This HIPAA Business Associate Agreement ("Agreement") is entered into on this
ISM day of , 2003, by and between the City of Tamarac, a Florida
municipal corporation #th a principal address of 7525 Northwest 88th Avenue, Tamarac
Florida 33321 ("CITY") and Advanced Data Processing, Inc. (a Delaware Corporation)
with a principal address of 520 NW 165 Street, Suite 201, Miami FL 33169,
("CONTRACTOR"); this agreement is effective as of April 14, 2003.
Whereas, the parties have executed an agreement whereby CONTRACTOR
provides medical billing services to CITY and CONTRACTOR receives, has access to, or
creates Health Information in order to provide those services; and
Whereas, CITY is a covered entity pursuant to the Health Insurance Portability
and Accountability Act of 1996 ("HIPAX) and the regulations thereunder and wishes to
disclose certain information to CONTRACTOR or allow CONTRACTOR to create or
receive information on behalf of CITY pursuant to the terms of this agreement, some of
which may constitute Protected Health Information (PHI); and
Whereas, CITY and CONTRACTOR intend to protect the privacy and provide for
the security of PHI disclosed to CONTACTOR pursuant to this agreement in compliance
with HIPAA and the HIPAA regulations, and other applicable law; and
Whereas, the purpose of this agreement is to satisfy certain standards and
requirements of HIPAA and the HIPAA regulations, as the same may be amended from
time to time.
Now, therefore, in consideration of the foregoing recitals and mutual covenants
herein contained and other good and valuable considerations the receipt and sufficiency
of which are hereby acknowledged, the parties agree as follows:
1. CONTRACTOR shall carry out its obligations under this Agreement in
compliance with the privacy regulations pursuant to Public Law 104-191 of
August 21, 1996, known as the Health Insurance Portability and Accountability
Act of 1996, Subtitle F-Administrative Simplification, Sections 261, et seq., as
amended ("HIPAA"), to protect the privacy of any personally identifiable
Protected Health Information ("PHI") that is collected, processed or learned as a
result of the legal services provided to CITY of Tamarac by CONTRACTOR. In
conformity therewith, CONTRACTOR agrees that it will:
a. Not use or further disclose PHI except as permitted under this Agreement or
required by law;
b. Use appropriate safeguards to prevent use or disclosure of PHI except as
permitted by this Agreement;
{
City of Tim wac .. n
r
c. To mitigate, to the extent practicable, any harmful effect that is known to
CONTRACTOR of a use or disclosure of PHI by the CONTRACTOR in
violation of this Agreement;
d. Report to CITY any use or disclosure of PHI not provided for by this
Agreement of which CONTRACTOR becomes aware;
e. Ensure that any agents or subcontractors to whom CONTRACTOR provides
PHI, or who have access to PHI, such as other consulting companies, agree
to the same restrictions and conditions that apply to CONTRACTOR with
respect to such PHI;
f. Make PHI available to CITY and to the individual who has a right of access as
required under HIPAA;
g. Incorporate any amendments to PHI when notified to do so by CITY;
h. Provide an accounting of all uses or disclosures of PHI made by
CONTRACTOR as required under the HIPAA privacy rule;
i. Make its internal practices, books and records relating to the use and
disclosure of PHI available to the Secretary of the Department of Health and
Human Services for purposes of determining CONTRACTOR'S and CITY'S
compliance with HIPAA; and
j. At the termination of this Agreement, return or destroy all PHI received from,
or created or received by CONTRACTOR on behalf of CITY, and if return is
infeasible, the protections of this agreement will extend to such PHI.
2. The specific uses and disclosures of PHI that may be made by CONTRACTOR
on behalf of CITY include, but are not limited to;
a. The preparation of invoices to patients, carriers, insurers and others
responsible for payment or reimbursement of the services provided by CITY
to its patients;
b. Preparation of reminder notices and documents pertaining to collections of
overdue accounts;
c. The submission of supporting documentation to carriers, insurers and other
payors to substantiate the health care services provided by CITY to its
patients or to appeal denials of payment for same.
d. Uses required for the proper management of CONTRACTOR'S business.
e. Other uses or disclosures of PHI as permitted by the HIPAA privacy rule.
2
4 9
c1tj of I all orac
........ ........
� r
3. Notwithstanding any other provisions of this Agreement, this Agreement may be
terminated by CITY, in its sole discretion, if CITY determines that
CONTRACTOR has violated a term or provision of this Agreement pertaining to
CITY'S obligations under the HIPAA privacy rule, or if CONTRACTOR engages
in conduct which would, if committed by CITY, would result in violation of the
HIPAA privacy rule by CITY.
City of T marac
1
14
By: ��-
Print Name:
Title:
Date: `7 — __0
Advanced Data Processing, Inc.
By:
Print Name:
Title:
Date: 7 - / y - v.;
3
Exhibit 2
61
ADVANCED ,
DATA PROCESSING, INC.
Advanced Data Processing, Inc.
ORDER FORM FOR MAILING THE HIPAA NOTICE OF PRIVACY PRACTICES
City of Tamarac
Advanced Data Processing, Inc.
7525 NW 88`" Ave
520 NW 165treet
Tamarac, FL 33321
Suite 201
Contact: Chief Paul Forsberg
Miami FL 33169
Phone: 954 724-2528
Contact Darryl Hartung
Telephone: 305459-0653
Facsimile: 305-521-0776
PROCESSING SERVICES
ices Please see pricing below
For Emergency Transports
FEES FOR MAILING THE HIPAA NOTICE OF PRIVACY PRACTICES
464 $1.00 $464.00
The average number of emergency transports calculation is determined by your previous transport history.
GENERAL COMMENTS
• The HIPAA Notice of Privacy Practices ("NPP") will be mailed to all emergency transport patients within the
timeframe allowed under the HIPAA regulations.
AUTHORIZATION
Client Signature: -
Printed Name:
Title/Position: ` /7 /" , —rAY
Date:
ADPI Signature:
Printed Name: a �-
Title/Position: - <?
Date: c; / r