Government-Funded Claims & Appeals Service Agreement

1. Appointment and scope

Client appoints Rosenthal Community Care Services LLC (RCCS) to provide administrative claims-recovery and appeal support concerning eligible past-due, unpaid, delayed, reduced, or denied reimbursement identified in this Agreement and accepted by RCCS.

RCCS will use reasonable professional efforts to review available claim history, payer correspondence, payment or remittance information, supporting records, documentation gaps, applicable deadlines, correction opportunities, reconsideration or reopening options, and administrative appeal pathways that may be available.

RCCS may communicate with Client and, when properly authorized and appropriate, with payers or other involved parties. The service does not include litigation, legal representation, a legal opinion, medical advice, coding certification, or a guarantee of payment.

2. Recovery-fee percentage

The recovery-fee percentage entered in this Agreement applies to the amount successfully recovered on Covered Claims under this engagement. The percentage shown in the signed PDF controls this engagement unless the parties later modify it in a written agreement.

The recovery fee is due within 14 calendar days after the payer issues or makes available the applicable recovery, including a check, EFT, payment, credit, offset, or other recovery defined by the parties.

3. Administrative Deposit

The Administrative Deposit is calculated separately for each participating facility, identified by its applicable NPI number and/or CDSS facility number.

The required Administrative Deposit is the higher of $1,000 per facility or $1,000 for every $100,000 of unpaid claims covered by this engagement. Any partial $100,000 increment is rounded up to the next $1,000 deposit level.

The Administrative Deposit is paid to allow RCCS to begin dedicating professional time and resources to the matter. It is not an additional recovery fee. If a recovery is achieved, the Deposit is credited dollar-for-dollar toward the applicable recovery fee.

4. Deposit refund and partial recovery

If no recovery is successfully collected during the applicable 12-month Administrative Deposit Protection period measured from the Complete File Date, RCCS will return the Administrative Deposit in full, provided Client cooperated with RCCS during document or information requests and provided accurate and timely responses throughout the claims process.

The Deposit is non-refundable when any recovery is successfully collected under the engagement, even if the recovered amount is less than the total unpaid claims, even if only one of several residents’ claims is recovered, or even if other claims are not recovered. In those circumstances, the Deposit is credited toward the recovery fee.

If the calculated recovery fee is less than the Administrative Deposit, RCCS will refund the excess within 10 business days. For example, a $4,000 recovery at a 20% recovery fee creates an $800 fee. After applying the $1,000 Deposit, RCCS will refund the $200 excess within 10 business days.

5. Client cooperation and information

Client agrees to provide complete, accurate, and timely information and documents reasonably requested by RCCS; identify relevant payer communications; provide access to records reasonably necessary to evaluate the claim; respond to questions; and complete any client action reasonably required for the administrative process.

RCCS may pause work or the applicable protection period while waiting for Client information. Materially false information, withheld records, repeated nonresponse, missed client obligations, or interference with the process may affect Deposit refund eligibility and RCCS’s ability to pursue the matter.

6. Exclusive engagement

During the applicable engagement and recovery-tail period, Client will not knowingly submit the same Covered Claim through another claims-recovery or appeals provider without first notifying RCCS in writing. This requirement helps prevent conflicting submissions, duplicated work, and inconsistent representations.

If RCCS materially works a Covered Claim and a recovery is later received during the applicable engagement or recovery-tail period, the recovery-fee obligation remains governed by this Agreement even if another person or organization later becomes involved.

7. No guarantee and payer control

RCCS will do its best to pursue eligible reimbursement, but does not guarantee approval, recovery, a specific recovery amount, payment timing, appeal success, collectible percentage, lookback period, or any particular payer decision. Every claim depends on its facts, documentation, payer rules, filing limits, authorization requirements, and available administrative remedies.

Client remains responsible for the accuracy of its records, ongoing eligibility, care and billing documentation, facility operations, and all decisions made after receiving RCCS support.

8. Electronic records, confidentiality, and legal terms

This Agreement may be executed electronically. Client’s typed name, signature date, submission timestamps, IP address, approximate signing location, device information, and record hash may be retained as an electronic signing record. The RCCS countersignature becomes effective when Client validly submits this Agreement and uses the same effective date shown in the Agreement.

The parties will use reasonable efforts to protect non-public business, financial, resident-related, operational, and claim information. Client should provide only information reasonably necessary for the claim and should avoid sending unnecessary protected health information through unsecured channels.

This Agreement is governed by California law. The parties will first attempt to resolve disputes informally. If a dispute cannot be resolved informally, it will be handled as provided by applicable law and any enforceable dispute-resolution provision in the parties’ written service terms.