CSP018844_Contract_REV.pdf

Index No.: INS011

Eff. Date: 01/01/25

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: SURPRISE BILLING—ARBITRATION ENTITY SERVICES

CONTRACT NUMBER: CSP018844 EFFECTIVE DATES: 01/01/24 TO 12/31/24

* Renewal through 12/31/26

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

SRC0000012940 that opened on 10/25/23. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the Ohio Department of Insurance as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

https://procure.ohio.gov/

*Indicates a twenty-four (24) month renewal, effective January 1, 2025 through December 31, 2026

Eff. Date: 01/01/24

MUTUALLY AGREED UPON TERMS AND CONDITIONS

The following terms and conditions were mutually agreed upon by the State and Contractor. Contractor will utilize the current payment methodology as follows:

• Contractor will render a decision according to the timelines specified in Ohio law, regardless of payment having been received from the parties. In collecting payment after the decision has been rendered, the non-prevailing party will pay seventy percent of the arbitrator’s fees, and the prevailing party will pay thirty percent.

• Contractor will not issue a default decision based on a party’s payment or non-payment of fees. Contractor will render a decision in accordance with Ohio law based on the information submitted by the parties.

COST SUMMARY

Surprise Billing – Arbitration Entity Services

CSP018844

UNSPSC CATEGORY CODE: 80000000, 80122001

DESCRIPTION

UNIT OF

MEASURE

ALL-INCLUSIVE FLAT FEE

(CONTRACT INCEPTION

THROUGH 12/31/24)

*ALL-INCLUSIVE FLAT FEE

(01/01/25 THROUGH

12/31/26)

Arbitrated claim (completed) [Flat fee includes all scope of work activities and deliverables.]

EACH

$427.71

$427.71

All costs must be in U.S. Dollars.

The State will not be responsible for any costs not identified.

There will be no additional reimbursement for travel or other related expenses.

The Contractor will solely be responsible for collecting arbitration fees from participating entities.

*Indicates insertion of renewal period and associated cost

Eff. Date: 01/01/24

CONTRACTOR INDEX

CONTRACTOR, TERMS, AND SHIPMENT: BID CONTRACT NO.: CSP018844

0000259635 TERMS: Net 30 Days Federal Hearings and Appeal Services 117 W. Main St.

Plymouth, PA 18651

REMIT TO ADDRESS:

Federal Hearings and Appeal Services 117 W. Main St.

Plymouth, PA 18651

CONTRACTOR'S CONTACT:

James L. Bobeck, CEO Telephone: 570-779-5122

E-mail address: jbobeck@fhas.com

*SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

1 01/01/25

This Amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the Contractor, this contract shall be renewed for a period of twenty-four (24) months, effective January 1, 2025 through December 31, 2026. Additionally, this amendment is issued to insert the renewal period cost and adds the Summary of Amendments page to the contract. All other prices, terms and conditions remain unchanged.

*Indicates adding the Summary of Amendments page