ContractPrevention Services Agreement • March 4th, 2014
CENPATICO PREVENTION SERVICES AGREEMENT DELIVERABLES SCHEDULE / EXHIBIT E GILA COUNTY HEALTH DEPARTMENTORIGINATION DATE: 09/01/2010 REVISED: 01/01/2014 REPORT FREQUENCY: WITHIN 24 HOURS, 48 HOURS, WEEKLY, AS REQUESTED, OR AS APPLICABLE Reference Deliverable Due Date & Where To Send PD-101 Provider Data Demographic Information FormMust use Cenpatico approved form. Within (2) two business days of any change to demographic information for all practitioners, sites, or facilities.E-mail azdeliverables@cenpatico.com RF-1005 Incidents, Accidents, and Death Report See PM Form 7.4.1 Within 48 hours of the incident Fax to 866.601.0111 RF-1010 Complaint Resolution Confirmation Response, if applicable. Within two (2) business days of the requestFax to 866-601-0111 RF-1015 Unexpected material change that could impact the Provider Network including change of address Within one (1) business day of becoming aware of the change. E- mail: azdeliverables@cenpatico.com RF-1016 Expected material ch
SCOPE OF WORK – ARTICLE I PROFESSIONAL REQUIREMENTS AND PROVISIONSPrevention Services Agreement • March 5th, 2014
