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Wittman Enterprises, LLC <br />Assignment Authorization <br />Included on all invoices and statements mailed out by Wittman Enterprises, LLC for the City is <br />an assignment of benefit authorization that is mandatory for Medicare billing. If the signature is <br />not obtained at the time of service by the field crews, we will release the invoice to the patient <br />for completion. It is important to note that release of billing to Medicare is not permitted without <br />the signature of the patient, designated guardian or witnessed declaration that the patient is not <br />able to sign. If the field crews are not required to obtain the signature or witness the patient's <br />inability to sign at time of service, billing and therefore payment will be significantly delayed. <br />3.1.2 -3.1.5 BILLING FUNCTIONS, RECORD MAINTENANCE, THIRD PARTY <br />CLAIM, AND CROSS REFERENCE OF PATIENT ACCOUNTS <br />Supplies and Equipment <br />Wittman Enterprises, LLC provides all supplies, equipment, and services necessary to perform <br />the provisions of the RFP at no additional cost to the City. Supplies, equipment, and services <br />include but are not limited to: <br />• All computer hardware and software necessary to perform accurately and efficiently the <br />processes as described in this RFP <br />• All mailing forms, billing forms, insurance forms, lien forms, and envelopes necessary to <br />perform the billing functions <br />• Any postage necessary to mail billing or information to patients, insurance companies, <br />3rd parties, and attorneys <br />• Availability of a national toll free 800 number for patients, the City, Insurance <br />companies, attorneys, 3rd parties to call for information or discussion of account status <br />Electronic Billing of Claims <br />As a matter of course, Wittman Enterprises, LLC electronically bill the City's Medicare and <br />Medi -Cal claims resulting in payment in 14 days and 7 days respectively. California is unique in <br />its number of Medicare and Medi -Cal HMO payers. When we receive a trip indicating Medicare <br />or Medi -Cal coverage, we verify this information through electronic verification systems in order <br />to be certain of billing correctly the first time. These claims are transmitted daily using ANSI, the <br />format set forth under the HIPAA requirements. <br />City of Santa Ana Fire Department <br />14 <br />