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Willman Linerpriwv. LL( <br />Assi.-nment :authorization <br />In, :1Lided on .111 Ilivdices and srrtenlents iiiiiled out by Wittman Enterprises. LLC for the City is <br />:! "i a;si�,nnlent of benetit authoriialion that is mandatory for Nledicare billing. If the sib nature is <br />k,btained at the time of ser%lce h_ the 11CId CI'CvvS. uC will release the invoice to the patient <br />fol' coniplellon. It 1s 1111INT1311l to note th,lt relL'ase oI blllinf to Me,hC :arc 1S not pCrInItted %yIthOUt <br />the �J�'71a1111'e i1t lI1C paltellL dCSI'_Ilated - LKIF(iriin Ur mine sed declar.ttloll that the patient IS Ilol <br />crevv-S are not required to obtain the <br />l:i,ll`':':Ity to inn at tlnl'.' i�t ��1 "t itness the patients , <br />We. <br />Ui11111� and thercl'ore pavII?erll \�Ill lie d laved. <br />?.1.2-3.1.5 BILLING FIACTIO \S, RFCORU MAINTENAACE-, THIRD P:1RTN <br />CI. V NI, AND CROSS REFERENCE OF PATIENT AC,COI NTS <br />Supplies and Equipment <br />Enterprises. LLC prov Ides all supplies. egUipmcni. and sery ices nccessary to perform <br />V'%J�Jons of the l"I 1' at no additiollal Cost It? the (altv. SUI)I?IIQS. egrllpinellt. Lind serA'lees <br />n ,U.le '' ut ,ire not hillitCd to' <br />• <br />All Computer hard\ \arc and softV \arc lleccssarA to perform accurmck and etf cienik the <br />proCesses as described III tills RIT <br />• \11 111,111111! li'J'ill.ti. hl�lli ?`� !or[I1S. IilUrallCe toi "111s, Ilen forms, Gild e11 \elopes Il:l'Cssart to <br />I'eI "IOI "Ill the billillt tuiletlolls <br />• 1nv postage necessary to snail I)illin,0 or information to patient;. insurancC companies. <br />?rd parties, 'Ind attorne\ s <br />• \v,lilahility oI, rl national toll free SM) number for patient >. the City. Insurance <br />c.?Inpani <,. attorriev S. parties to call for information or diSLUSslon of aCCOUnt status <br />Electronic Killino. of Claims <br />As .t hatter rt' course. 1� ittlnan Flitcrprises. LLC electronicall., hill the ('11% �s Medicarc and <br />Mcdi-Cal claims rcsultin in payment in 14 d iv s and 7 days respcctivcly. California is unique in <br />its number of Medicare and Niedi -Cal 1I\IO pad crs. When vve receive a trip indicating 'Medicare <br />or Medi -Cal c:mera,_,c. vve verit'% this information throat h electronic verification ;v"stcma in order <br />tLl be certain ,f'hillin�_ corrcrtll. the first time. These claims are transiniited bank using_ _1 \SI, the <br />forinat s.t filrth under the 1IIP_A.1 requirements. <br />Cin• o/ Santa Ana Fire Department <br />25C -13 <br />