Emergency Physician Fund Terms and Conditions

FACILITY AND PHYSICIAN ELIGIBILITY REQUIREMENTS

Emergency and Trauma Provider must first complete the Emergency Physician Fund (EPF) Application and submit it to Traffic Accident Assistance Program (TAAP).

Have a fully executed HIPAA Agreement between Physician and EPF. EPF will accept the Physician’s HIPAA Agreement.

TAAP will make the determination regarding claims that are eligible for consideration for funding.

EPF’s consideration is limited to emergency and trauma patients with unresolved claims for services and the provider has used best efforts to determine that there is no private, health plan, federal or third-party source of potential payment. For a claim to be considered for funding, the following criteria must be met:

1. The patient is unable or unwilling to pay for services rendered to them.

2. The patient has no private health coverage or any form of coverage at time of trauma.

3. The patient is not covered by any federally funded program which includes Medicare, Medicaid or Medi-Cal or the VA.

CLAIM BILLING EFFORTS

Provider’s accounts to be reviewed for the purpose of funding shall not include any receivables for person’s covered by federal Medicare programs, or a state funded Medicaid program or any other federal or state health care program as such persons are excluded from the Emergency Physician Fund (EPF) program consideration.

Further provider must have used best efforts to qualify the person with any available state Medicaid program as well as any and all other payor sources. Provider has exhausted all efforts to collect directly from the person for the health care services provided to them during their stay. Finally all efforts to get reimbursed by the person have ceased and the provider has assigned the account to bad debt or as uncollectible.

Provider offered a reduced amount, a percentage of billed charges to the patient without any results.

If provider received actual written notification from the patient or the patient’s representative that no payment will be made for the services provided this information should be conveyed to EPF.

Provider must exhaust all sources for payment on patient’s claim and stand that no payment will be forthcoming from a third-party or from any federal, state or commercial health plan and that provider has not received any payment related to the claim.

FUNDING

EPF shall issue funds to provider within 15 business days of the approval of a claim. Payment to the provider shall be only for the provider’s trauma services.

All claims paid by EPF will be considered a purchase of the receivable and all payments are accepted as full and final with all rights and remedies assigned to EPF.