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Agmt74 California Dental Servic
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Agmt74 California Dental Servic
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Last modified
7/5/2005 2:53:21 PM
Creation date
6/10/2002 11:15:18 AM
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Template:
Agreement
Contractor Name
California Dental Service
PROJECT NAME
dental care service
RMP File Number
304
Date
2/1/1974
Reso Ref
7144
Box
2450
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8. TERMINATION FOR NON-PAYMENT <br /> In the event that any payment due pursuant to paragraph l(b) of General Agreements is not paid when due, COS <br /> may give written notice that payment is due, and if such payment is not received within 1§ days after such notice, COS <br /> may, at its option, terminate all further benefits and be released from all further obligations hereunder; provided, <br /> however, that COS shall make payment to dentists for dental services 3uthorized by COS prior to termination and for <br /> dental services which are rendered without prior authorization by a dentist prior to receipt by him of notice of such <br /> termination of benefits. In the event of termination pursuant to this paragraph, EMPLOYER shall remain liable to CDS <br /> for the full amount of all dentists' statements paid or otherwise discharged by COS, plus ~.'1 . 4 [3e~'ce~l~ of <br /> such amount (to compensate COS for its administration of the dentai program), less amounts actually paid by <br /> EMPLOYER to CDS. <br /> <br /> g. Both parties to this Agreement agree to consult to the extent reasonably practical concerning all material'published <br /> or distributed relating to this Agreement. No such material shall be published or distributed which is contrary to the <br /> terms of this Agreement. <br /> <br />10. Both parties to this Agreement agree to permit and encourage the professional relationship between dentist and patient <br />to be maintained without interference. <br /> <br />11. If any portion of this Agreement or any Amendment thereof sha~l be determined by any arbitrator, court or other com- <br />petent authority to be illegal, void or unenforceable, such determination shall not abrogate this Agreement or any portion <br />thereof other than such portion determined to be illegal, void or unenforceable, and all other portions of this Agreement <br />shall remain in full force and effect. <br />12~ The parties agree that all questions regarding the interpretation or enforcement of this Agreement shall be governed by <br />the laws of the State of California, where the Agreement was entered into and is to be performed. <br />13. (il CDS shall prepare and furnish to each participating dentist and to any other dentist or eligible patient on request a <br />standard form to make a claim for payment for services covered by this Agreement. In order to make a claim for payment, <br />such form, duly completed in accordance with the terms thereof and signed by the dentist who performed the services and <br />by the eligible patient (or the patient's parent or guardian if such patient is a minor) shall be submitted to CDS at the ad- <br />dress shown thereon. <br /> <br /> (ii) CDS shall notify each claimant who submits a claim in accordance with subparagraph (il above if such claim is <br />denied, in whole or in part, stating the reason or reasons for the denial. Within 60 days after receipt of such notice a claimant <br />may make a written request for review of such denial, by addressing such request to CDS, P.O. Box 7736, San Francisco, <br />California 94120, Telephone (415) 864-9800, Attention: Benefit Services Department, stating the reasons the claimant <br />believes that the denial of the claim was in error and any pertinent documents which the claimant wishes to review. The <br />Benefit Services Department of CDS will review the claim. If the review involves a determination as to the quality of services <br />provided or the appropriateness of fees charged, and the matter cannot be resolved by ODS to the ~atisfaction of the claim- <br />ant, it will be referred to a peer review committee of the appropriate dental society or association which will accept <br />jurisdiction, and CDS agrees to be bound by the determination of such peer review committee. Unless reference to a peer <br />review committee is required or other unusual circumstances arise, a decision on a request for review shall be provided and <br />communicated to the claimant in writing within 120 days after receipt of a request for review. <br /> <br /> 11-75-N-3 <br /> <br /> <br />
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