| Line Item Description: Gastroenterology evaluation, consultation, diagnostic and treatment of eligible Ryan White clients determined by plan of care and referred by the Department to the Provider at a rate based on the attached fee schedule not to exceed the amount of this purchase order. Ryan White is always the payor of last resort. The fee schedule priced at Medicaid/Medicare rates is attached and includes: 1. GI Pro rate reimbursement by CPT cote and code description 2. Units of Anesthesiology CPT & MCR B reimbursement rates 3. Facility expected reimbursement rates A prior referral approval form from any Area 4 County Health Departments (Baker Clay -Duval -Nassau and St Johns) is needed for initiation of services. Treatment plan must be authorized for an eligible client by the Ryan White Lead Agency AIDS Program Office before service is rendered. Must submit a properly complete monthly invoice to the Ryan White Lead Agency- AIDS Program Office within 10 days of the following month at the mailing address: Florida Department of Health, Attn: Lorie S. Johnson, 921 North Davis St. Bldg. A MC 39, Jacksonville, FL, 32209. At a minimum, each invoice must be submitted on letterhead, and contain 1) a description of all deliverables for the invoice period, 2) number of units per deliverable, 3) total amount due per deliverable, 4) total invoice amount, 5) invoice number, 6) invoice date, and 7) period of services. Payments must be authorized only for service units on the invoice which are in accord with the fee schedule. Financial Consequences If the complete invoices are not received in our office by the 10th of the following month (as mentioned above) there will be financial consequences as follows: 1. 15 days of late submission: payment will be reduced by 10% 2. 30 days of late submission: payment will be reduced by 15% 3. Over 45 days of late submission: invoices will not be paid. |
| Method of Procurement: Exempt, health services including examination, diagnosis, treatment, prevention, medical consultation, or administration [s. 287.057(3)(e)5., F.S.] |
Line Split Details:
| Split Accounting Line Number: 1 |
| FLAIR Contract ID: |
| Org. Code and Description: 64361631113 - |
| Object Code and Description: 132010 - |
| Account Code: 64-20-2-141001-64200700-16-100777-00 |
| Split Amount: $15,000.00 |
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