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American Caresource Holdings is based out of Dallas. American CareSource Holdings, Inc. It offers ancillary network and management that provide outsourced solution for various healthcare payors and plan sponsors, including self-insured employers, indemnity insurers, preferred provider organizations, health maintenance organizations, third party administrators, and federal and local governments.

As of December 31, , it had contracts with approximately 2, ancillary healthcare service providers operating in approximately 25, sites. American CareSource sells its products through sales force, executive officers, and a network of independent brokers and consultants. The company was founded in and is based in Dallas, Texas. Whalewisdom has at least Form 4 filings The firm last filed a Form D notice of exempt offering of securities on We believe we can impact relationships with direct payors through various competitive avenues, such as assisting them with more competitive pricing and plan design.

Including , we have added 23 new clients, of which 20 were direct payors and TPAs. While we experienced obstacles to acquiring new client accounts in and , we believe that the ancillary savings and the reimbursement paid to clients for connectivity and maintaining electronic claims flow provide a solid value proposition to prospective clients.

Competition The Company faces four types of direct competitors. These larger carriers offer nation-wide, standardized products and often compete on a local level based of the cost-effectiveness of their national contracts. Our payors have selected us based on our extensive network of service providers and cost-savings potential. However, they may choose to develop their own network and contract directly with the providers instead of outsourcing ancillary management services to us in the future.

These regional competitors are generally managing their own home-grown network of ancillary care providers and are more likely to offer customized products and services tailored to the needs of the local community.

Table of Contents Research and Development The Company invests in its information technology infrastructure to enhance the capabilities of its databases, data retrieval tools, data exchange capabilities and claims processing engine. In addition, the Company believes that its extensive claims database of ancillary healthcare services and costs is a strategic asset.

The development expenses during those periods were related primarily to enhancements made to our internally developed claims management application. The enhancements allow the Company to develop and launch a variety of innovative products and services as well as gain competitive market advantage through faster and more accurate claims processing. Government Regulation The healthcare industry is extensively regulated by both the federal and state governments. A number of states have extensive licensing and other regulatory requirements applicable to companies that provide healthcare services.

Furthermore, federal and state laws govern the confidentiality of patient information through statutes and regulations that safeguard privacy rights. ACS and its clients may be subject to federal and state laws and regulations that govern financial and other arrangements among healthcare providers.

Furthermore, the Company and its clients may be subject to federal and state laws and regulations governing the submission of false healthcare claims to the government and private payors, mail pharmacy laws and regulations, consumer protection laws and regulations, legislation imposing benefit plan design restrictions, various licensure laws, such as managed care and third party administrator licensure laws, drug pricing legislation, and Medicare and Medicaid reimbursement regulations.

Among other things, the health reform legislation includes insurance industry reforms including, but not limited to guaranteed coverage requirements, elimination of pre- existing condition exclusions and annual and lifetime maximum limits, and restrictions on the extent to which policies can be rescinded; creation of new market mechanisms through the creation of health benefit exchanges; and creation of new and significant taxes on health insurers and, in some circumstances healthcare benefits.

Provisions of the health reform legislation become effective at various dates over the next several years. The Department of Health and Human Services "HHS" , the Department of Labor and the Treasury Department have yet to issue some of the necessary enabling regulations and guidance with respect to the health care reform legislation. Due to the breadth and complexity of the health reform legislation, the scope of implementing regulations and interpretive guidance, in addition to regulations and guidance yet to be issued, and the phased-in nature of the implementation, it is difficult to predict the overall impact of the health reform legislation on our business over the coming years.

Possible adverse affects of the health reform legislation include reduced revenues, increased costs, exposure to expanded liability, and requirements for us to revise the ways in which we conduct business or risk of loss of business. In addition, our results of operations, our financial position and cash flows could be materially adversely affected.

The law also requires issuers to provide annual rebates to their enrollees if their medical loss ratio "MLR" does not meet specific targets. The new regulations apply to issuers offering group or individual health insurance coverage.

Under the MLR regulations, an issuer's MLR is calculated as the ratio of i incurred claims plus expenditures for activities that improve health care quality to ii premium revenue. The two key aspects to this calculation involve what comprises an 'incurred claim' and what qualifies as an 'expenditure for health care quality improvement.

Specifically, incurred claims represent the total of direct paid claims, unpaid claim reserves, change in contract reserves, reserves for contingent benefits, the claim portion of lawsuits and any experience rating refunds. Prescription drug rebates received by the issuer and overpayment recoveries from providers must be deducted from incurred claims. Also, the following amounts are explicitly excluded and therefore may not be included in the calculation of incurred claims: i amounts paid to third party vendors for secondary network savings; ii amounts paid to third party vendors for network development, administrative fees, claims processing, and utilization management; or iii amounts paid, including amounts paid to a provider, for professional or administrative services that do not represent compensation or reimbursement for covered services provided to an enrollee.

The regulations themselves provide examples of specifically excluded amounts. With regard to amounts paid for network development as noted in ii above , if an issuer contracts with a behavioral health, chiropractic network, or high technology radiology vendor, or a pharmacy benefit manager, and the vendor reimburses the provider at one amount but bills the issuer a higher amount to cover its network development, utilization management costs, and profits, then the amount that exceeds the reimbursement to the provider must not be included in incurred claims.

With regard to administrative services as noted in iii above , medical record copying costs, attorneys' fees, subrogation vendor fees, compensation to paraprofessionals, janitors, quality assurance analysts, administrative supervisors, secretaries to medical personnel and medical record clerks must not be included in incurred claims.

In order to properly classify what activities 'improve health care quality', the activity must be designed to improve health quality, increase the likelihood of desired health outcomes, be directed toward individual enrollees or incurred for the benefit of specific segments of enrollees, or be grounded in evidence based medicine. The regulations also contain a list of 14 expenditures that are specifically excluded from 'improvement of health care quality' activities.

It is possible that a portion of the fees our existing and prospective payors are contractually required to pay us and that do not qualify as 'incurred claims' may not be included as expenditures for activities that improve health care quality. This may reduce our net revenues and profit margins. The Company must continually adapt to new and changing regulations in the healthcare industry.

If we fail to comply with these applicable laws, we may be subject to fines, civil penalties, or criminal prosecution. If an enforcement action were to occur, our business and financial condition may be adversely affected.

Employees As of February 25, , the Company had 56 full-time employees and no part-time employees. Risk Factors. The Company has two clients which account for a substantial portion of its business. Revenue from one will likely stop by the end of and revenue from the other will likely continue to decline. The client contract with Viant expired on May 20, but automatically renewed for a one-year period and renews for successive one- year periods unless either party delivers a written notice of non-renewal at least 90 days prior to expiration.

Since the Company has not received written notice of non-renewal, the contract term has been automatically extended through May 20, At this time, MultiPlan began methodically moving its payor client groups to its existing networks. Revenue from Viant has declined as its business has been integrated with its acquiror, which was complete at December 31, We don't expect significant revenue or claims volume from the account in Additionally, an adverse change in the financial condition of HealthSmart, including an adverse change as a result of a change in governmental or private reimbursement programs, could have a material adverse effect on our business and results of operations.

Recent and pending healthcare reforms could materially adversely affect our revenues, financial position and our results of operations. The enactment and implementation of healthcare reforms at the federal or state level may affect certain aspects of our business, including contracting with ancillary healthcare service providers; administrative, technology or other costs; provider reimbursement methods and payment rates; premium rates; coverage determinations; mandated benefits; minimum medical expenditures; claim payments and processing; drug utilization and patient safety efforts; collection, use, disclosure, maintenance and disposal of individually identifiable health information; personal health records; consumer-driven health plans and health savings accounts and insurance market reforms; and government-sponsored programs.

Other provisions of the health reform legislation become effective at various dates over the next several years. The HHS, the Department of Labor and the Treasury Department have yet to issue some of the necessary enabling regulations and guidance with respect to the health care reform legislation. The Company has a history of losses. With the exception of the three years from to , the Company has incurred losses in each year of its existence. The Company will need to return to levels of claims volume and revenue as it had in through in order to return to profitability.

With the decline in revenues from its two largest clients, and with less than equivalent increases from other clients, we cannot determine when or if the Company can return to profitability.

No assurances can be given that the Company's current operating volumes will not continue to decline in the future. Management is exploring alternative strategies for either expanding our available services or identifying other business opportunities that could enhance our performance.

Any such efforts could prove to be costly and may not necessarily lead to increased revenue or profitability. The length of the current sales cycle may impede the Company's efforts to add new client accounts. During and , our sales cycle lengthened and we sold only four and six new accounts, respectively. The sales cycle was negatively impacted by the competitive nature of negotiating with TPA's and direct payors, turnover in our sales and marketing function, the obtrusive nature of our implementation process and prospects' conflicting priorities, primarily related to technology compliance projects.

Despite efforts to strategically improve our sales and marketing function, we can give no assurances that it will not continue to be a lengthy process to convert a sales prospect into a new client account and that our revenues will not continue to decline due to the lack of new client accounts.

The current state of the global economy may reduce our revenue and profitability and harm our growth prospects. The Company's results have been impacted by the state of the economy during the past three years. First, the unemployment rate has caused fewer people to participate in insurance programs with our clients.

Second, plan participants, seeking to spend less money, appear to be making less frequent use of some ancillary services. Third, client consolidation within our industry has adversely affected our business. Fourth, the uncertainty surrounding healthcare reform is negatively impacting healthcare spending patterns. To the extent that these trends continue, or become worse, we may receive less revenue and our profitability and growth could be adversely affected, depending on the extent of the declines.

Some of these potential competitors may be our current clients. Traditional health insurance companies, specialty provider networks, and specialty healthcare services companies are potential competitors of the Company. These entities include well-established companies that may have greater financial, marketing and technological resources than we have. Pricing pressure caused by competition has caused many of these companies to reduce the prices charged to clients for core services and to pass on to clients a larger portion of the formulary fees and related revenues received from service providers.

In fact, our clients could choose to establish their own network of ancillary care providers. As a result, we would not only lose the benefit of revenue from such clients, but we could face additional competition in our market. The Company is dependent upon payments from third party payors who may reduce rates of reimbursement.

Competition for patients, efforts by traditional third party payors to contain or reduce healthcare costs and the increasing influence of managed care payors, such as health maintenance organizations, have resulted in reduced rates of reimbursement in recent years.

Also, under the MLR regulations included in the Affordable Care Act, it is possible that a portion of the fees our existing and prospective payors are contractually required to pay us and that do not qualify as 'incurred claims' may not be included as expenditures for activities that improve health care quality.

The Company is dependent upon its network of qualified providers and its provider agreements may be terminated at any time. The development of a network of qualified providers is an essential component of our business strategy. The typical form of agreement from ancillary healthcare providers provides that these agreements may be terminated at any time by either party with or without cause.

If these agreements are terminated, specifically with one of our significant provider relationships, such ancillary healthcare providers could enter into new agreements with our competitors which would have an adverse effect on our ability to continue our business as it is currently conducted.

For any given claim, the Company is subject to the risk of paying more to the provider than it receives from the payor. The Company has complete discretion in negotiating both the prices it charges its payors and the financial terms of its agreements with the providers.

For example, during and , approximately 5. There can be no assurances that the loss claim percentage will not be higher in future periods. Our business is dependent upon our ability to store, retrieve, process and manage data and to maintain and upgrade our data processing capabilities. An interruption of data processing capabilities for any extended length of time, loss of stored data, programming errors, other computer problems or interruptions of telephone service could have a material adverse effect on our business.

Numerous state and federal laws and regulations affect our business and operations. These laws and regulations include, but are not necessarily limited to: We believe we are operating our business in substantial compliance with all existing legal requirements material to the operation of our business.

There are, however, significant uncertainties regarding the application of many of these legal requirements to our business, and there cannot be any assurance that a regulatory agency charged with enforcement of any of these laws or regulations will not interpret them differently or, if there is an enforcement action, that our interpretation would prevail.

HIPAA provides safeguards to ensure the integrity and confidentiality of health information. Violation of the standards is punishable by fines and, in the case of wrongful disclosure of individually identifiable health information, fines or imprisonment, or both.

Although we provide thorough training to our employees and we intend to comply with all applicable laws and regulations regarding medical information privacy, failure to do so could have an adverse effect on our business. Limited barriers to entry into the ancillary healthcare services market could result in greater competition. There are limited barriers to entering our market, meaning that it is relatively easy for other companies to replicate our business model and provide the same or similar services that we currently provide.

Major benefit management companies and healthcare companies not presently offering ancillary healthcare services may decide to enter the market. These companies may have greater financial, marketing and other resources than are available to us.

Competition from other companies may have a material adverse effect on our financial condition and results of operations. The Company may be unsuccessful in hiring and retaining skilled employees. The future growth of our business depends on our ability to hire and retain skilled employees. The Company may be unable to hire and retain the skilled employees needed to succeed in our business. Qualified employees are in great demand throughout the healthcare industry.

Our failure to attract and retain sufficient skilled employees may limit the rate at which our business can grow, which will result in harm to our financial performance. We consider our methodologies, processes and know-how to be proprietary.

We seek to protect our proprietary information through confidentiality agreements with our employees, as well as our clients and contracted service providers.

There can be no assurance that the steps taken by the Company to protect its intellectual property will be successful. Monthly fluctuations in the number of claims we process and the types of claims we process will impact the quarterly and annual results of the Company. Our margins vary depending on the type of ancillary healthcare service provided, the rates associated with those services and the overall mix of these claims, each of which will impact our profitability.

Consequently, it may be difficult to predict our net revenue from one quarter to another quarter. As of February 25, , the Company had 5,, shares of its Common Stock outstanding. Some of our existing stockholders can exert control over us and may not make decisions that further the best interests of all stockholders.

As a result, these stockholders, if they act individually or together, may exert a significant degree of influence over our management and affairs and over matters requiring stockholder approval, including the election of directors and approval of significant corporate transactions. Furthermore, the interests of this concentration of ownership may not always coincide with our interests or the interests of other stockholders and, accordingly, they could cause us to enter into transactions or agreements which we would not otherwise consider.

Our common stock is listed on The NASDAQ Capital Market, and we are therefore subject to continued listing requirements, including requirements with respect to the market value of publicly-held shares and minimum bid price per share, among others, and requirements relating to board and audit committee independence.

The Company was provided calendar days, or until March 19, , to regain compliance. In a letter dated March 20, , NASDAQ stated that although the Company had not regained compliance with the Minimum Bid Price Requirement by March 19, , it is eligible for an additional day compliance period, or until September 17, , based on the Company meeting the continued listing requirements for market value of publicly held shares and all other applicable standards for initial listing on the NASDAQ Capital Market except for the Minimum Bid Price Requirement and having notified NASDAQ of its intention to cure the deficiency during the second compliance period by effecting a reverse stock split, if necessary.

At the Company's annual meeting of stockholders, held on June 11, , the stockholders voted to amend the Company's certificate of incorporation for the purposes of effecting a reverse stock split and authorized its Board of Directors to determine, in its sole discretion, whether to effect the amendment, the timing of the amendment, and the specific ratio of the reverse stock split, provided that such ratio is 1-for-2, 1-for- 2.

Because the Amendment did not result in a reduction in the number of authorized shares of Common Stock, its effect was to increase the number of shares of Common Stock available for issuance relative to the number of shares issued and outstanding. On the Effective Day, every three shares of the Company's Common Stock issued and outstanding immediately prior to the Effective Day were automatically combined into one share of Common Stock. Stockholders that were left with a fraction of a share as a result of the reverse split received cash in lieu of the fractional share in an amount based on the closing sale price of the Common Stock on the business day immediately preceding the Effective Day as reported on the The Nasdaq Capital Market.

In addition, any options, warrants and restricted stock units outstanding as of the Effective Day were adjusted accordingly. As a result of the reverse split, the Company had 5,, shares of common stock issued and outstanding as of December 31, If we fail to so comply, our stock may be delisted. Table of Contents Item 2.

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Deprtment of health and himan services center for medicare medicaid Cummins filters country code in the location address of the provider being identified. Is Organization Subpart. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. Exclusive Provider Organization. It offers ancillary network and management that provide outsourced solution for various healthcare payors and plan sponsors, including self-insured employers, indemnity insurers, preferred provider organizations, health maintenance yoldings, third party administrators, and federal and local governments.
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American CareSource Holdings, Inc. It offers ancillary network and management that provide outsourced solution for various healthcare payors and plan sponsors, including self-insured employers, indemnity insurers, preferred provider organizations, health maintenance organizations, third party administrators, and federal and local governments. As of December 31, , it had contracts with approximately 2, ancillary healthcare service providers operating in approximately 25, sites.

American CareSource sells its products through sales force, executive officers, and a network of independent brokers and consultants. The company was founded in and is based in Dallas, Texas. Whalewisdom has at least Form 4 filings The firm last filed a Form D notice of exempt offering of securities on Form D is a form to be used to file a notice of an exempt offering of securities with the Securities and Exchange Commission.

From time to time, the Company reviews its provider relationships to determine whether any changes to the relationship are appropriate through sanction monitoring and other methods. The Company believes that credentialing providers represents a valuable service to both its payors and the providers in the network, who would, in the absence of such service, be forced to undergo the credentialing process with respect to each payor with whom they enter into a service relationship.

We process those claims and charge the payor according to its contractual rate for the services according to our contract with the payor. In processing the claim, we are paid directly by the payor or the insurer for the service.

We then pay the provider of service according to its independently-negotiated contractual rate. We assume the risk of generating positive margin, the difference between the payment we receive for the service and the amount we are obligated to pay the provider of service. The Company may receive a claims submission from a payor either electronically or via a paper based claim.

How We Deliver Services Ancillary network analysis. This analysis identifies service providers that are not already in our network. We attempt to enter into agreements with such service providers to maximize discount levels and capture a significant volume of previously out-of-network claims. In addition, the analysis enables the Company to set a client fee schedule that will bring value through incremental savings on the ancillary service charges. Ancillary custom network. ACS customizes its network to meet the needs of each payor.

Ancillary network management. The Company manages ancillary service provider contracts, reimbursement and credentialing for its payors. This not only provides administrative benefits to our payors, but reduces the burden on our contracted service providers who typically must supply credentialing documentation to payors and engage in contract negotiations with separate payors.

The Company has created a proprietary software system that enables us to manage many different customized accounts and includes the following modules: Ancillary reporting. ACS offers a complete suite of reports to each payor on a monthly basis. These reports cover contracting efforts and capture rates, client savings, volumes by service category and complete claims and utilization reports and other information of value to the client.

Ancillary healthcare claims management. The Company has the capability of performing a number of customized processes that may add additional value for each payor. As part of the claims management process, we manage the documentation requirements specific to each payor. This service provides a labor cost savings to the payors and providers. Ancillary claims collections management. The Company facilitates an expedited claims collection process by ensuring receipt of the claim by the payor, providing information to the payor required for processing the claim, tracking the status of the claim throughout the process and maintaining a team of customer service representatives to resolve any issues that might delay the collections process.

The Company believes that the providers in its network are paid more effectively and efficiently than would otherwise be the case. Ancillary data insights. The Company has developed and continues to develop an extensive database of ancillary healthcare claims history.

The data provides insights into utilization and pricing across a wide variety of service categories, geographies, and service providers. The Company has the ability to market this data as a value added service to its payors in the design of custom networks, and the development of ancillary healthcare management programs.

As more and more care is delivered in highly cost effective out-patient and ancillary care settings, the need for better organization and cost containment will only increase over the next several years. For example, contracting with ancillary healthcare service providers is difficult without a specific focus on the market.

This is due to the disparate nature of ancillary healthcare services and the fact that these services are offered by a wide array of providers, ranging from small independent practitioners to regional specialty practices, national providers and providers within hospital systems. Since this market is so diverse, it has historically not been a focus of the major health plans and payors.

The Company believes that because it has developed a substantial network of providers, because it has established a sustainable advantage in this market by becoming an aggregator of these services for health plans, and because it has been retained by substantial payors, it can offer healthcare providers a substantial number of patients who are entitled to receive services from payors. In addition, our "ancillary only" contracting focus allows us to be independent of any hospital relationships that may encourage retaining all ancillary services within the more expensive hospital setting.

The Company has invested to develop its ancillary service provider network both proactively, across geographical and healthcare specialties, and reactively to address specific client needs. With market strength in specific geographic areas, the Company has been able to develop favorable rates with ancillary service providers and create an attractive product offering healthcare cost savings to regionally-based clients in those areas.

In order to enhance its ability to recruit and manage its network of providers, the Company offers a suite of value added services specifically designed to help ancillary care service providers lower their cost of doing business by assuming the responsibility for the most complex and costly interactions with payors.

The Company seeks growth by increasing its client payor-base and service provider relationships by focusing on providing in-network services for its payors and aggressively pursuing TPAs, insurance companies, large self-funded organizations and employer groups.

The Company continues to derive a substantial amount of its net revenues from its traditional PPO relationships, but we focus on TPAs and direct payors that represent self-insured employer groups. Thus, the Company believes that there is a large market opportunity involved in providing a highly competitive ancillary care alternative to the standard service offered by the major national insurers in select regional markets across the country.

The Company aggregates the lives of its various clients into buying power that exceeds the market power of any one of its clients individually. During , our relationships with TPAs and direct payors exposed us to approximately 1.

While we are also exposed to additional covered lives through our PPO relationships including our most significant client , because we do not have direct relationships with the individual payors, it is difficult to estimate the additional number of covered lives to which we have access.

The volume of collective lives we manage allows us to obtain more favorable pricing than our clients can generally obtain on their own. Currently, the Company utilizes both a new business sales organization of six senior sales professionals four full-time employees and two sales consultants as well as an account management team of two professionals to contract with new payor organizations and then maximize the revenue and margin potential of each new payor.

The new business sales team uses a variety of channels to reach potential clients including professional relationships, direct marketing efforts, attendance at industry-specific trade shows and conferences, and through strategic partnerships with market partners, independent brokers, and consultants. The account management team is engaged with each new payor to help manage the implementation process. The typical services the healthcare payors require the Company to provide include: The terms of the agreement between the Company and the payors do not contemplate that the payors will have any relationship with the service providers and, in fact, prohibit payors from claiming directly against the service providers.

The Company is responsible irrespective of the existence or terms of any agreement the Company has with the service providers. In addition, Viant Holdings Inc. Table of Contents In late , we entered into an amendment to our agreement with HealthSmart. The amendment extended the duration of the partnership between the Company and HealthSmart through December 31, On December 31, , the Company and HealthSmart entered into a three-year agreement to continue and expand the partnership between the two organizations.

Under the agreement, the Company will enhance its network of ancillary service providers to address markets outside of the commercial group health space and it will utilize an administrative fee rate differential to encourage HealthSmart to add payors that will access the Company network of ancillary providers.

The agreement is subject to an automatic two year renewal term. After this initial renewal term, the agreement will automatically renew for successive periods of one year unless earlier terminated by a party for breach or unless either party provides notice of non-renewal no less than ninety days prior to the expiration of the two year renewal term or any subsequent renewal term.

However, although our relationship with HealthSmart will continue, our agreement does not provide that we are their exclusive ancillary care network and they could engage other ancillary care providers directly into their network.

Accordingly, we cannot be certain of any level of continued volume from HealthSmart. As part of the new agreement, the agreement between the parties dated August 1, , as amended through December 31, , was terminated. Subsequent to the business combination, our client began to migrate its payors and employer groups to network alternatives, negatively impacting claims volume from our client.

While we have not received a formal termination notice from MultiPlan, the transition was completed as of December 31, , which eliminates any revenue and claims volume from the client in and thereafter. Because we have secondary relationships with these payors and cannot have a competitive impact on the payors, we have determined that it is in our best interest to pursue clients that are direct payors, primarily TPAs.

We believe we can impact relationships with direct payors through various competitive avenues, such as assisting them with more competitive pricing and plan design. Including , we have added 23 new clients, of which 20 were direct payors and TPAs. While we experienced obstacles to acquiring new client accounts in and , we believe that the ancillary savings and the reimbursement paid to clients for connectivity and maintaining electronic claims flow provide a solid value proposition to prospective clients.

Competition The Company faces four types of direct competitors. These larger carriers offer nation-wide, standardized products and often compete on a local level based of the cost-effectiveness of their national contracts. Our payors have selected us based on our extensive network of service providers and cost-savings potential. However, they may choose to develop their own network and contract directly with the providers instead of outsourcing ancillary management services to us in the future.

These regional competitors are generally managing their own home-grown network of ancillary care providers and are more likely to offer customized products and services tailored to the needs of the local community. Table of Contents Research and Development The Company invests in its information technology infrastructure to enhance the capabilities of its databases, data retrieval tools, data exchange capabilities and claims processing engine.

In addition, the Company believes that its extensive claims database of ancillary healthcare services and costs is a strategic asset. The development expenses during those periods were related primarily to enhancements made to our internally developed claims management application.

The enhancements allow the Company to develop and launch a variety of innovative products and services as well as gain competitive market advantage through faster and more accurate claims processing. Government Regulation The healthcare industry is extensively regulated by both the federal and state governments.

A number of states have extensive licensing and other regulatory requirements applicable to companies that provide healthcare services. Furthermore, federal and state laws govern the confidentiality of patient information through statutes and regulations that safeguard privacy rights.

ACS and its clients may be subject to federal and state laws and regulations that govern financial and other arrangements among healthcare providers. Furthermore, the Company and its clients may be subject to federal and state laws and regulations governing the submission of false healthcare claims to the government and private payors, mail pharmacy laws and regulations, consumer protection laws and regulations, legislation imposing benefit plan design restrictions, various licensure laws, such as managed care and third party administrator licensure laws, drug pricing legislation, and Medicare and Medicaid reimbursement regulations.

Among other things, the health reform legislation includes insurance industry reforms including, but not limited to guaranteed coverage requirements, elimination of pre- existing condition exclusions and annual and lifetime maximum limits, and restrictions on the extent to which policies can be rescinded; creation of new market mechanisms through the creation of health benefit exchanges; and creation of new and significant taxes on health insurers and, in some circumstances healthcare benefits.

Provisions of the health reform legislation become effective at various dates over the next several years. The Department of Health and Human Services "HHS" , the Department of Labor and the Treasury Department have yet to issue some of the necessary enabling regulations and guidance with respect to the health care reform legislation.

Due to the breadth and complexity of the health reform legislation, the scope of implementing regulations and interpretive guidance, in addition to regulations and guidance yet to be issued, and the phased-in nature of the implementation, it is difficult to predict the overall impact of the health reform legislation on our business over the coming years.

Possible adverse affects of the health reform legislation include reduced revenues, increased costs, exposure to expanded liability, and requirements for us to revise the ways in which we conduct business or risk of loss of business. In addition, our results of operations, our financial position and cash flows could be materially adversely affected.

The law also requires issuers to provide annual rebates to their enrollees if their medical loss ratio "MLR" does not meet specific targets. The new regulations apply to issuers offering group or individual health insurance coverage. Under the MLR regulations, an issuer's MLR is calculated as the ratio of i incurred claims plus expenditures for activities that improve health care quality to ii premium revenue.

The two key aspects to this calculation involve what comprises an 'incurred claim' and what qualifies as an 'expenditure for health care quality improvement. Specifically, incurred claims represent the total of direct paid claims, unpaid claim reserves, change in contract reserves, reserves for contingent benefits, the claim portion of lawsuits and any experience rating refunds. Prescription drug rebates received by the issuer and overpayment recoveries from providers must be deducted from incurred claims.

Also, the following amounts are explicitly excluded and therefore may not be included in the calculation of incurred claims: i amounts paid to third party vendors for secondary network savings; ii amounts paid to third party vendors for network development, administrative fees, claims processing, and utilization management; or iii amounts paid, including amounts paid to a provider, for professional or administrative services that do not represent compensation or reimbursement for covered services provided to an enrollee.

The regulations themselves provide examples of specifically excluded amounts. With regard to amounts paid for network development as noted in ii above , if an issuer contracts with a behavioral health, chiropractic network, or high technology radiology vendor, or a pharmacy benefit manager, and the vendor reimburses the provider at one amount but bills the issuer a higher amount to cover its network development, utilization management costs, and profits, then the amount that exceeds the reimbursement to the provider must not be included in incurred claims.

With regard to administrative services as noted in iii above , medical record copying costs, attorneys' fees, subrogation vendor fees, compensation to paraprofessionals, janitors, quality assurance analysts, administrative supervisors, secretaries to medical personnel and medical record clerks must not be included in incurred claims. In order to properly classify what activities 'improve health care quality', the activity must be designed to improve health quality, increase the likelihood of desired health outcomes, be directed toward individual enrollees or incurred for the benefit of specific segments of enrollees, or be grounded in evidence based medicine.

The regulations also contain a list of 14 expenditures that are specifically excluded from 'improvement of health care quality' activities. It is possible that a portion of the fees our existing and prospective payors are contractually required to pay us and that do not qualify as 'incurred claims' may not be included as expenditures for activities that improve health care quality.

This may reduce our net revenues and profit margins. The Company must continually adapt to new and changing regulations in the healthcare industry. If we fail to comply with these applicable laws, we may be subject to fines, civil penalties, or criminal prosecution. If an enforcement action were to occur, our business and financial condition may be adversely affected. Employees As of February 25, , the Company had 56 full-time employees and no part-time employees. Risk Factors.

The Company has two clients which account for a substantial portion of its business. Revenue from one will likely stop by the end of and revenue from the other will likely continue to decline. The client contract with Viant expired on May 20, but automatically renewed for a one-year period and renews for successive one- year periods unless either party delivers a written notice of non-renewal at least 90 days prior to expiration.

Since the Company has not received written notice of non-renewal, the contract term has been automatically extended through May 20, At this time, MultiPlan began methodically moving its payor client groups to its existing networks. Revenue from Viant has declined as its business has been integrated with its acquiror, which was complete at December 31, We don't expect significant revenue or claims volume from the account in Additionally, an adverse change in the financial condition of HealthSmart, including an adverse change as a result of a change in governmental or private reimbursement programs, could have a material adverse effect on our business and results of operations.

Recent and pending healthcare reforms could materially adversely affect our revenues, financial position and our results of operations. The enactment and implementation of healthcare reforms at the federal or state level may affect certain aspects of our business, including contracting with ancillary healthcare service providers; administrative, technology or other costs; provider reimbursement methods and payment rates; premium rates; coverage determinations; mandated benefits; minimum medical expenditures; claim payments and processing; drug utilization and patient safety efforts; collection, use, disclosure, maintenance and disposal of individually identifiable health information; personal health records; consumer-driven health plans and health savings accounts and insurance market reforms; and government-sponsored programs.

Other provisions of the health reform legislation become effective at various dates over the next several years. The HHS, the Department of Labor and the Treasury Department have yet to issue some of the necessary enabling regulations and guidance with respect to the health care reform legislation.

The Company has a history of losses. With the exception of the three years from to , the Company has incurred losses in each year of its existence. The Company will need to return to levels of claims volume and revenue as it had in through in order to return to profitability.

With the decline in revenues from its two largest clients, and with less than equivalent increases from other clients, we cannot determine when or if the Company can return to profitability. No assurances can be given that the Company's current operating volumes will not continue to decline in the future.

Management is exploring alternative strategies for either expanding our available services or identifying other business opportunities that could enhance our performance. Any such efforts could prove to be costly and may not necessarily lead to increased revenue or profitability.

The length of the current sales cycle may impede the Company's efforts to add new client accounts. During and , our sales cycle lengthened and we sold only four and six new accounts, respectively. The sales cycle was negatively impacted by the competitive nature of negotiating with TPA's and direct payors, turnover in our sales and marketing function, the obtrusive nature of our implementation process and prospects' conflicting priorities, primarily related to technology compliance projects.

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WebThe organization American Caresource Holdings was founded in We have found information about 2 employees who work here. The organization is based in TX. The . WebJan 2, аи AMERICAN CARESOURCE HOLDINGS, forbiddenplateauroadassociation.com 03/04/13 for the Period Ending 12/31/12 Address LYNDON B. JOHNSON FREEWAY SUITE . WebTexas (US) Branch Branch of AMERICAN CARESOURCE HOLDINGS, INC. (Delaware (US)) Registered Address. TRISTAR DR STE ; IRVING; ; TX; USA; .