Wisconsin In-Network Transportation Provider Checklist

shall continue to perform its obligations hereunder regardless of any outstanding contestedamounts.If Provider must first bill Medicare, the 60-day timeframe shall begin on the date of the denial ofthe claim by Medicare.LGTC pays properly submitted uncontested invoices twice per month by check or electronictransfer within thirty days after submission. If a payment date falls on a weekend or holiday,payments will be made on the next working weekday.In the event that the Client is unable or unwilling to pay LGTC amounts validly due under theClient Contract, LGTC may delay payments to Provider until such time as the Client pays theoutstanding amounts.Invoice RequirementsOnce per week Provider shall submit to LGTC all completed trip logs pertaining to the previousworkweek, including the signatures of the applicable Participants. Improperly completed triplogs will be returned to Provider and payment will be denied for either the entire trip log or forindividual trips reported thereon, whichever is applicable. Included with each batch of trip logs,Provider shall submit a summary invoice that will include performance information. Providershall use trip log and summary invoice sheet forms that are provided by LGTC. LGTC reservesthe right to modify the format of the trip log and summary sheet from time to time. Providermay use alternative trip log or summary invoice sheet forms only with the express writtenconsent of LGTC.Trip logs must be free of excessive changes. Changes on the trip log should be made with asingle line through the text so that the original text remains visible (i.e., no whiteouts, blackoutsor complete obscuring of original text). Any changes on the trip log should be dated andinitialed by the driver. LGTC reserves the right to deny individual trips or entire trip logs thatevidence excessive changes pending confirmation of the details of such changes with Provider.Charges Against InvoicesIf requested or otherwise required by the Client Contract, LGTC may provide certain driverand/or attendant training and/or orientation services to Provider free of charge. LGTC’s cost toproduce the materials distributed to Provider (or employees of Provider) pursuant to thesetraining and/or orientation services will be deducted from Provider’s invoice following suchtraining or orientation services.In addition, LGTC has entered into an agreement with an independent credentialing company fornationwide access to credentialing and screening services for drivers. This company offers theminimum level of credentialing required by LGTC at a highly competitive rate. Provider mayuse the independent credentialing company and access the rates negotiated by LGTC for suchservices or it may use an alternative vendor, pre-approved by LGTC, to complete the necessarycredentialing requirements. If Provider uses the independent credentialing company then theactual cost of such services shall be deducted from Provider’s invoice as a pure pass through costwithout additional profit or surcharge applied by LGTC.Wisconsin NET ProgramVersion: March 25 2011Page 31