PHYSICIAN ELIGIBILITY REQUIREMENTS
Physician 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.
EPF will make the determination regarding claims that are eligible for consideration for funding.
EPF’s consideration is limited to trauma patients without the ability to pay for services and the Physician 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 commercial 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
Physician’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 Physician must have used best efforts to qualify the person with any available state Medicaid program as well as any and all other payor sources. Physician has exhausted all efforts to collect directly from the person for the health care services provided to them during their stay at the Physician. Finally all efforts to get reimbursed by the person have ceased and the Physician has assigned the account to bad debt or as uncollectible.
Physician offered a reduced amount, a percentage of billed charges to the patient without any results.
If Physician 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 ETF.
Physician 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 Physician has not received any payment related to the claim.
FUNDING
ETF shall issue funds to Physician within 15 business days of the approval of a claim. Payment to the Physician shall be only for the Physician’s technical component for the trauma services. Professional fees for physicians are not eligible for this fund. Physicians must apply through the Emergency Physician Compensation.
All claims paid by ETF will be considered a purchase of the receivable and all payments are accepted as full and final with all rights and remedies assigned to ETF.