CONTRACT SPECIFICATIONS

Master Billing Services Agreement (MBSA) and Service Line Addenda (SLA)

CONTRACT SPECIFICATIONS for Master Billing Services Agreement (MBSA) and Service Line Addenda (SLA)

Date:

Client Name:

Client Code:

Sage Healthy Contact

Referral or Group

Indicate the terms for each Service Line being contracted.

SERVICE LINE

FEES

MINIMUM

START DATE

NOTES

A-1

Billing and Collection

Fill In % with two decimals

Fill in $ value

Date / Time

Text Input

A-2

Eligibility Services (EV, PA)

Drop Down

Describe

Fill in $ value

Date / Time

Text Input

A-3

Revenue Cycle Review (“HealthCheck”)

Fill in $ value

Date / Time

Text Input

A-4

Compliance Services

Fill in $ value

Date / Time

Text Input

A-5

Credentialing Services

Fill in $ value

Date / Time

Text Input

A-6

Recovery & Restoration
(incl. A/R Clean-up)

Fill In % with two decimals

Fill in $ value

Date / Time

Text Input

A-7

Custom Strategy + Operations Solutions

Fill in $ value

Date / Time

Text Input

A-8

Business Process Outsourcing

Fill in $ value

Date / Time

Text Input

A-9

Marketing Services

Fill in $ value

Date / Time

Text Input