License and Services Agreement Credentialing Services
The following are the terms and conditions pursuant to which GreenThumb Revenue, LLC shall provide Credentialing
Services (defined below) if purchased by Licensee through an Order Form:
1. License and Services Agreement Terms. Unless otherwise modified in this Agreement, the terms and conditions of the License
and Services Agreement (including all Exhibits and Attachments thereto) (the “Agreement ”) shall continue to govern the rights
and obligations between the Licensee and GreenThumb Revenue, LLC. Any terms of the Agreement which are not in conflict
with provisions of this Agreement shall act to supplement the terms of this Agreement for the provision of the Credentialing
Services contemplated herein.
2. Credentialing Services
a. GreenThumb Revenue, LLC shall provide the following Credentialing Services (“Credentialing Services”):
i. submit and verify receipt of the credentialing application to designated health plans;
ii. follow up on the application with designated health plans; and
iii. document receipt of requested information by designated health plan,
iv. conduct follow-up activities, document acceptance or rejection information from the plan.
b. Credentialing Services include submission of additional information requested by designated health plans during the
credentialing and enrollment process; however, this does not include submission of different health plan applications for
same provider or new applications for other providers.
c. GreenThumb Revenue, LLC shall be under no obligation to perform any additional services.
3. Licensee’s Responsibilities.
a. Licensee shall assist GreenThumb Revenue, LLC in completing a credentialing profile for each Provider, and the
business entity, if applicable, to whom Credentialing Services are provided. A credentialing profile may be initiated
by submitting a signed copy of a standard credentialing implementation form, or provide login information to a
complete CAQH profile for downloading credentialing data.
b. Licensee shall submit all required documents and required information (“Credentialing Information”) necessary to
complete the credentialing application(s).
c. Licensee agrees to provide any information or assistance required by GreenThumb Revenue, LLC to fulfill its obligations
under this Agreement in a timely manner. Such assistance shall include, but not be limited to, requests for additional
information, supporting documents, document signatures.
d. Licensee agrees to provide all Credentialing Information without delay. Licensee understands and acknowledges that
delays in providing the Credentialing Information may result in delay in the completion of or rejection of credentialing
of the concerned Provider.
e. Licensee warrants that the Credentialing Information provided is accurate and complete. Licensee agrees to disclose all
adverse actions from state licensing boards, health plans, healthcare facilities, government health programs,
professional organization, medical specialty board, or any other healthcare organization related to his or her professional
practice from the time of graduating medical school; as well as any criminal convictions related to professional
practice, along with any additional information which may be essential to GreenThumb Revenue, LLC providing
5 of 10
4. Payment Terms
a. The fee to initiate, process and submit the Credentialing Information will be $125 per Application for
the initial request. The Fee will include the submission to of all the Clients requested Insurance Plan. Fee is
due before any services are rendered.
b. If at a later date (90 days past the signature of this Agreement ) Client would like to credential
another Insurance company, there will be a $50 service charge.
5. In the event that the Licensee fails to deliver any of the Credentialing Information within the requested
period, GreenThumb Revenue, LLC will charge an additional fee ($50) for requesting, obtaining and
submitting the credentialing applications.
6. The Licensee acknowledges and agrees that there are no refunds or returns for the Services, including
applications that are denied participation by a health plan. If there is a dispute about the Services, the
Licensee may contact GreenThumb Revenue, LLC and GreenThumb Revenue, LLC will work to resolve the
dispute. If GreenThumb Revenue, LLC is unable to credential a provider with a particular health plan due to a
closed network, then GreenThumb Revenue, LLC will re-apply to the network once (if allowed by the plan)
with no additional costs during any subscription period or renewal period. In no case will GreenThumb Revenue,
LLC “substitute” another network application for a denied network application.
5. Term & Termination.
a. Term. This Agreement shall be effective upon the Effective Date and shall be terminated once a response
to the Credentialing Information of the Licensee is received from the concerned health plan.
b. Termination by GreenThumb Revenue, LLC. GreenThumb Revenue, LLC may immediately terminate this
Aggrement upon Licensee’s refusal to pay fees as outlined in this Agreement . Termination of services for
this reason will not excuse Licensee from the total amount due under this Agreement if services have
already been started or performed.
c. Effect of Termination. Upon expiration or termination of this Addendum: (i) GreenThumb Revenue, LLC shall
be entitled to receive any unpaid fees earned through the date of termination, and in the event of early
termination the total of all payment amounts that would have been due through the end of the term; and
(ii) GreenThumb Revenue, LLC shall cease performing any and all Credentialing Services hereunder.
6. No Guarantees / Warranty
a. GreenThumb Revenue, LLC makes no guarantee and does not warrant network approval of Providers,
granting of privileges by any healthcare facility, approval of any type of credentialing application,
approval of any license application, turn around / response time of health plan credentialing and
contracting, reimbursement by a third party payer network for practitioner services, or profitability of
Licensee or practitioner.
b. Licensee acknowledges that GreenThumb Revenue, LLC disclaims any liability due to any enrollment
application being rejected, delayed, not received, for any reason which is beyond the reasonable control
of GreenThumb Revenue, LLC, due to any action or inaction of the Licensee.
c. The Licensee agrees and acknowledges that credentialing is a process that may include unforeseen delays.
The Licensee agrees that it will not proceed with provision of services that require the completion of the
credentialing process without confirmation from GreenThumb Revenue, LLC that the Credentialing Services
have been completed.
a. Indemnification: Licensee agrees to indemnify, defend, and hold harmless GreenThumb Revenue, LLC and
its directors, officers, employees, agents, representatives, successors, assigns, subcontractors, members and
affiliates from and against any and all claims, demands, actions, settlements or judgments, including
6 of 10
reasonable attorneys’ fees and litigation expenses arising from the
negligence, actions or omissions of Licensee or their employees or agents; breaches of this Agreement by
the Licensee; inaccurate, incomplete or false Credentialing Information or any relevant
information provided to GreenThumb Revenue, LLC by Licensee or its practitioners; Licensee’s failure
to provide accurate information or disclosure of all adverse actions of practitioners.
b. Authority: GreenThumb Revenue, LLC shall have the authority to conduct the Credentialing Services required
by the Licensee, as set forth herein, subject only to the express limitations herein set forth. In fulfilling its duties
and obligations hereunder, GreenThumb Revenue, LLC shall have all such authority, rights and powers as
are necessary, advisable or consistent herewith and the exercise of the authority conferred by this
Agreement on GreenThumb Revenue, LLC shall serve to bind Licensee and shall constitute the act of