Please select the Panels you want to get credentialed with.

Date:

Plan Project start Completetion date Cost

Notes:

  • Project Start Date is from when application has been submitted to panel.
  • Est. Completion Date is estimated completion timeframe, can be done sooner.
  • All Requested information/docs must be received before applications are submitted. Apps will not be submitted until all required info has been received.
  • * With Corona virus dates may be subject to change.

Let's start with the basic information

This Service Agreement (AGREEMENT) is entered into by and DENmaar mHealth, LLC on this day Sep 09, 2020.

WITNESSETH

WHEREAS, DENmaar mHealth, LLC provides medical credentialing services to entities throughout the United States and at its principal offices.

WHEREAS, Client desires to outsource credentialing duties including enrollments and has retained DENmaar mHealth, LLC to provide medical credentialing services and related services as agreed upon by both parties.

NOW, THEREFORE, in consideration for the mutual covenants contained herein, and other good and valuable consideration, the receipts and sufficiency of which is hereby acknowledged, the parties agree as follows:

  1. TERM. Credentialing service agreements are for specific services performed over the term period of: 6 months
  2. DESCRIPTION OF WORK. Client agrees to hire DENmaar mHealth, LLC to perform new payer credentialing and/or re-credentialing services as outlined in the Project Timeline attached to the Invoice.
  3. PAYERS. A “payer” consists of a major medical insurance carrier, worker’s compensation carrier, NPI application or CAQH application. Medicare, Medicaid and certain other insurance networks are considered “specialty payers” because they are state run and do not utilize CAQH to credential providers.
  4. COMPENSATION. Client will compensate and make payment to DENmaar mHealth, LLC for the amount designated in the attached Payment Schedule. DENmaar mHealth, LLC fees are non-refundable once the credentialing process has begun. Paypal payments are accepted and can be made directly.
  5. PROVIDER INFORMATION. Client agrees to provide DENmaar mHealth, LLC with all necessary information in order to complete the credentialing process. Client information and documentation should be directed to DENmaar mHealth, LLC directly via email or fax to 1-888-386-5121. Client may submit copies of documents (CV, Diploma, and License) via electronic submission or fax.
  6. PAYER ENROLLMENT. Client retains DENmaar mHealth, LLC for the purpose of performing credentialing tasks on their behalf. DENmaar mHealth, LLC does not guarantee that the Client will gain acceptance onto payer panels, as this is at the discretion of the payer. Furthermore, DENmaar mHealth, LLC is not liable for closed panels or denial due to negative circumstances in Client’s background or problems with the Client’s credentials provided.
  7. DUTIES UPON TERMINATION OF THIS AGREEMENT. Upon the termination of this Agreement, regardless of the reason or circumstances for said termination, DENmaar mHealth, LLC shall return any and all original and copies of Client’s records as applicable, forms, reports provided to DENmaar mHealth, LLC, credentialing materials, vendor contracts or any other written information pertaining to Client’s course of business. Upon the termination of this Agreement, regardless of the reason or circumstances for said termination, Client shall provide any and all compensation due at the point of termination for the entirety of the Agreement.
  8. CONFIDENTIALITY. DENmaar mHealth, LLC will use its best efforts to maintain privacy and confidentiality of any private Client information and/or patient information the DENmaar mHealth, LLC may be privy to during the term of this Agreement. DENmaar mHealth, LLC maintains sensitive client information primarily in electronic form. All documents and client information in digital form are maintained in a secure database and are not accessible by any third party via the Internet. Any paper records containing client information will be secured in DENmaar mHealth, LLC’s secure offices. DENmaar mHealth, LLC will never share Client information with any third party without their permission. DENmaar mHealth, LLC will maintain inactive client information for a period up to three (3) years unless the client requests their information to be destroyed at an earlier date upon termination of services. All electronic information will be permanently deleted from the DENmaar mHealth, LLC database and any paper documents will be shredded.
  9. TRANSACTION FEES. Completed credentialing applications will be returned to Client in electronic form or paper form if wet (original) signature is required. Client is responsible for any additional postage resulting from the credentialing process. Enrollment fees, such as those with CAQH or applications, are the responsibility of the Client. DENmaar mHealth, LLC does not add any surcharge to application, license or other credentialing fees paid to a third party. Fees can be paid through DENmaar mHealth, LLC or by the Client directly.
  10. POINT OF CONTACT. Client agrees to designate one (1) person to serve as a point of contact through the credentialing process.
  11. GOVERNING LAW. This Agreement is being delivered and is intended to be performed in the State of Arizona and shall be interpreted, construed, constructed and enforced in accordance with the laws of the State of Arizona.
  12. INDEMNIFICATION. DENmaar mHealth, LLC agrees to indemnify and hold harmless the Client and its directors, trustees, officers, and employees from and against any and all claims and liabilities (including reasonable attorney’s fees and expenses incurred in the defense thereof), to the extent arising out of the acts or omissions of DENmaar mHealth, LLC and/or its employees or agents in connection with the duties under this agreement. The Client agrees to indemnify and hold harmless DENmaar mHealth, LLC and its directors, trustees, officers, and employees from and against any and all claims and liabilities (including reasonable attorney’s fees and expenses incurred in the defense thereof), to the extent arising out of the acts or omissions of the DENmaar mHealth, LLC and/or its employees or agents in connection with the duties under this agreement.
  13. ATTORNEY’S FEES. Should it become necessary by either party to enforce this Agreement by court action, the prevailing party in the action shall be entitled to recover all reasonable attorney’s fees and court costs incurred, including reasonable attorney’s fees at the Appellate level.
  14. NOTICES. For the purposes of this Agreement, written notice is effective three (3) business days from the date postmarked by U.S. Mail or other registered or certified carrier to the following addresses. Client notices will be sent to the designated Point of Contact unless otherwise specified by the Client. All notices to DENmaar mHealth, LLC shall be sent to via email or fax.
  15. SEVERABILITY. The invalidity of enforceability of any provision of this Agreement shall not affect the other provisions hereof, and the Agreement shall be construed in all respects as if such invalid or unenforceable provisions were omitted.
  16. MODIFICATION. This Agreement cannot be modified or changed except by written instrument signed by both DENmaar mHealth, LLC and Client.
  17. ENTIRE AGREEMENT. This Agreement contains the entire agreement of the parties and there are no other promises or conditions in any other agreement whether oral or written. This Agreement supersedes any prior written or oral agreements between the parties. This Agreement is 3 pages inclusive of any appendixes and/or attachments.
  18. TERMNATION OF SERVICES. Company may choose to terminate the contract at any time through written communication to DENmaar mHealth, LLC. Once the contract is terminated, Company will not be responsible for any additional payments other than for items completed prior to termination date.
  19. RCM/EHR/APP ACCESS. Company will have full access to system use, including credentialing and EHR. Options for Private pay with DENpay and merchant account requires a separate signup. Upon payment of credentialing applications completion, Client may elect to continue use for a monthly fee, or elect to use our billing services, which will allow for continued use.

I, HAVE READ AND UNDERSTOOD THE TERMS SET FORTH IN THE AFORESAID CREDENTIALING SERVICE AGREEMENT AND FREELY AGREE TO AND ACCEPT THESE TERMS.

AGREED TO AND ACCEPTED THIS

DENmaar mHealth, LLC