Wisconsin In-Network Transportation Provider Checklist

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X. THIRD PARTY WEBSITESThe Software may contain or reference links to websites operated by third parties(“Third Party Websites”). These links are provided as a convenience only. Such ThirdParty Websites are not under the control of Logisticare. Logisticare is not responsible forthe content of any Third Party Website or any link contained in a Third Party Website.Logisticare does not review, approve, monitor, endorse, warrant, or make anyrepresentations with respect to Third Party Websites, and the inclusion of any link in theSoftware or Services is not and does not imply an affiliation, sponsorship, endorsement,approval, investigation, verification or monitoring by Logisticare of any informationcontained in any Third Party Website. In no event will Logisticare be responsible for theinformation contained in such Third Party Website or for Users use of or inability to usesuch website. Access to any Third Party Website is at Provider’s own risk, and Provideracknowledges and understands that linked Third Party Websites may contain terms andprivacy policies that are different from those of Logisticare. Logisticare is notresponsible for such provisions, and expressly disclaims any liability for them.XI.HIPAA COMPLIANCEThe Software and Services provide features for managing health care relatedtransportation in a manner that complies with the Health Insurance Portability andAccountability Act of 1996 (“HIPAA”). Provider agrees to use the Software andServices in a manner consistent with HIPAA and all applicable federal and state privacylaws relating to medical or health information.XII.TERM AND TERMINATION(A) This Agreement shall have a term of one year from the date of execution byLogistiCare and will automatically renew for successive one year terms. This Agreementshall terminate automatically without notice or action of either Party at such time asProvider’s Transportation Agreement with LogistiCare Solutions, LLC is terminated.Logisticare reserves the right, in its sole discretion, to terminate Users access tothe Software and Services or any portion thereof at any time, without notice. Upontermination, users must immediately cease using the Software and Services. Anytermination of this Agreement shall not affect LogistiCare’s rights hereunder. Further,Provider agrees that upon termination of this Agreement as provided in this Section XIIor cancellation of the subscription by users in accordance with Section IV, Logisticareshall not be liable to Provider, Users or any third party for any termination of access tothe Software or Services.(B) In addition to its other rights of termination, Logisticare shall have the right toterminate this Agreement and the right of use granted herein in the event the Provider (i)ceases conducting business in the normal course; (ii) initiates proceedings for theliquidation or winding up of the Provider’s business or for the termination of its corporatePage 70
charter; (iii) becomes insolvent or unable to pay its debts as they mature or makes anassignment for the benefit of its creditors; (iv) is the subject of a voluntary petition inbankruptcy or any voluntary proceeding relating to insolvency, receivership, liquidation,or composition for the benefit of creditors, if such petition or proceeding is not dismissedwithin sixty (60) days of filing; (v) becomes the subject of any involuntary petition inbankruptcy or any involuntary proceeding relating to insolvency, receivership,liquidation, or composition for the benefit of creditors, if such petition or proceeding isnot dismissed within sixty (60) days of filing; (vi) is liquidated or dissolved; (vii) isadjudicated by a court of competent jurisdiction as being bankrupt or insolvent; or (viii)becomes subject to direct control by a receiver, liquidator, trustee, or assignee inbankruptcy or insolvency.(C) Provider may terminate this Agreement at any time by providing ten (10) daysadvance written notice to LogistiCare.XIII.NONCOMPETITION(A) Provider agrees that, during the term of this Agreement and for five (5) yearsafter termination of this Agreement, Provider or its Users will not, directly or indirectly,use the Websites, Software and Services in any manner that would compete or tend tocompete with the business of Logisticare, including but not limited to brokering theprovision of health care related transportation, or to otherwise use the Websites, Softwareand Services for any commercial purpose except strictly in accordance with the terms ofthis Agreement.(B) Provider agrees that, during the term of this Agreement and for five (5) yearsafter termination of this Agreement, Provider or its Users will not write, develop,produce, sell, disseminate, disclose, lecture on, publish an article concerning, or offer aservice based on a software application that provides the same, or substantially the same,functionality as the Software, or a substantial portion thereof, without LogistiCare’s priorwritten consent.(C) Provider agrees that, during the term of this Agreement and for five (5) yearsafter termination of this Agreement, Provider or its Users will not assist a third party towrite, develop, produce, sell, disseminate, disclose, lecture on, publish an articleconcerning, or offer a service based on a software application that provides the same, orsubstantially the same, functionality as the Software, or a substantial portion thereof,without LogistiCare’s prior written consent.XIV. COPYRIGHT(A) All title and copyrights in and to the material and content of the Websites(“Content”) (including but not limited to any images, photographs, animations, video,audio, music and text incorporated into the Software), any accompanying printedmaterials, and any copies of the Software, are owned by Logisticare or its suppliers. ThisAgreement grants users no title to the Content or rights to use the Content.Page 71
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Please return all documents to:1275
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TRANSPORTATION AGREEMENT(the “Agr
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Provider may be withdrawn by LGTC,
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ii)iii)iv)scheduled B-Leg pick up t
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utilized by Provider.ii) The number
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• ADA regulations;• Client Cont
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vi)type of vehicle in which it is i
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and satisfactorily cleared a nation
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ix)a Participant, or in the presenc
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iv)Provider warrants that it has no
Page 21 and 22: a) name, date of birth and social s
Page 23 and 24: from establishing or maintaining se
Page 25 and 26: the dispute shall be referred for b
Page 27 and 28: EXHIBIT ALIQUIDATED DAMAGESThe Part
Page 29 and 30: Requirement:Provider must perform t
Page 32 and 33: To determine the payment amount LGT
Page 34 and 35: Exhibit B - Execution PageLOGISTICA
Page 36 and 37: scope of the employment or other pr
Page 38 and 39: or created or received by BUSINESS
Page 40 and 41: presenting a preponderance of the e
Page 42 and 43: EXHIBIT EMedicare Advantage Program
Page 44 and 45: information and data necessary for:
Page 46 and 47: e reviewed and approved by Health P
Page 48 and 49: Non-Emergency Medical Transportatio
Page 50 and 51: LOGISTICARE INSURANCE CREDENTIALING
Page 52 and 53: Please describe your hours of opera
Page 54 and 55: Network Development503 Oak Place, S
Page 56 and 57: AFTER HOURS CONTACTINFORMATION SHEE
Page 58 and 59: Form W-9 (Rev. 1-2003) Page 2Exampl
Page 60 and 61: Form W-9 (Rev. 1-2003) Page 4Part I
Page 62 and 63: Dear LogistiCare Transportation Pro
Page 64 and 65: Electronic Data Interchange (EDI) A
Page 66 and 67: Date: __________________________Log
Page 68 and 69: Software User AgreementWHEREAS, Log
Page 70 and 71: III.OWNERSHIPThe Software is protec
Page 74 and 75: (B) The Content may not be copied,
Page 76 and 77: this Agreement, or the infringement
Page 78 and 79: LogistiCare Driver ListLegal name D
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Wisconsin In-Network Transportation Provider Checklist

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