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X12 Transaction Assurance

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Independent assurance that X12 transactions produced and consumed by the combined entity are correct, complete and accepted by trading partners. ⚠ Supplier owns the outcome under this instrument: ACME defines what correct means and Supplier determines how to demonstrate it.

1. Parties, Instrument and Term

AttributeProvision
ClientACME Health
SupplierGallatin EDI Assurance
InstrumentSOW-03, issued under the Master Services Agreement
Vendor register referenceVN-03 in the Vendor Management Plan
VehicleFixed price, deliverable-based
ACME ownerW. Ferriday, VP Claims Operations
EffectiveAugust 28, 2023 — ⚠ subject to execution under §7
TermFrom execution through core administration cutover acceptance.
Governing documentVendor Management Plan §4 and §5. ⚠ Clauses in those sections are mandatory and are reproduced here in full rather than incorporated by reference.

2. Background and Purpose

The combined entity exchanges X12 transactions with trading partners who will not tolerate a period of instability at cutover. Supplier provides independent assurance that transactions produced and consumed after integration are correct, complete and accepted. Why the boundary is drawn here: ACME defines what correct means and builds the interfaces; Supplier determines how correctness is demonstrated and owns that outcome. ⚠ Assurance performed by the team that built the thing is not assurance.

3. Definitions

These terms carry the meaning below wherever they appear in this Statement of Work. Where a term is also defined in the Master Services Agreement and the two differ, the Master Services Agreement governs under §15.

TermMeaning in this Statement of Work
AcceptanceWritten confirmation by ACME that a Deliverable meets its stated Acceptance Criterion, or expiry of the review period in §5.1 without written rejection.
Acceptance CriterionThe objective, demonstrable condition stated against each Deliverable in §5. ⚠ A criterion that cannot be demonstrated is not a criterion.
DeliverableAn item Supplier is contractually obliged to produce under §5.
DefectA failure of delivered scope to perform in accordance with its Acceptance Criterion or the as-built documentation — as distinct from a request for new or changed function, which is a Change Order.
Client DependencyAn obligation of ACME under §6 on which Supplier performance depends.
Warranty PeriodThe 90 calendar days following Acceptance of the Deliverable concerned. ⚠ Not from delivery, and not from execution.
PHIProtected health information as defined under HIPAA, in respect of which the Business Associate Agreement at GC-06 governs.
Change OrderA written amendment under §9, executed by the same authorities that executed this Statement of Work.

4. Scope of Services

4.1 In scope — Supplier delivered

RefElementProvision
SC-01834 enrollment and maintenanceFull-file and change-file semantics per trading partner, effective dating, termination and reinstatement handling.
SC-02837 claimsInstitutional, professional and dental tested as separate rule sets, not as one format with options.
SC-03835 remittanceReconciled to the payment actually issued, across both paying platforms during coexistence.
SC-04270/271 eligibilityInquiry and response under load, including timeout and error behavior.
SC-05820 premium paymentReconciled against billing at group level.
SC-06Trading partner readiness⚠ Confirmation that each partner has re-registered and successfully exchanged test transactions — not merely that notice was sent.

4.2 Out of scope

The following are not Supplier scope under this instrument. They are stated because an exclusion nobody wrote down is an argument waiting to happen at the moment it is least affordable.

RefExcludedWhere it sits instead
EX-01Interface buildSupplier assures transactions; it does not build the interfaces.
EX-02Trading partner contractingPartner agreements remain ACME's.
EX-03Remediation of ACME defectsSupplier reports; ACME's teams fix.

5. Deliverables and Acceptance

Acceptance Criteria are stated here, before work begins. ⚠ A Deliverable is accepted when its criterion is demonstrated, not when Supplier declares it complete.

RefDeliverableAcceptance criterion
DL-01Test strategy and traceabilityEvery transaction set mapped to the business control that proves it
DL-02Executed test cycles per transaction set⚠ Acceptance is a business-level control total, not a 999 acknowledgment
DL-03Trading partner readiness registerPer partner, with evidence of a successful test exchange
DL-04Defect report with agingCounts reported with age; a stable count with rising age is a backlog
DL-05Assurance opinion at cutoverWritten opinion supporting the go/no-go decision

5.1 Acceptance process

Supplier submits each Deliverable in writing. ACME has 10 business days from submission to accept it or to reject it in writing. A rejection must cite the Acceptance Criterion the Deliverable fails and state what would satisfy it; a rejection doing neither is not a rejection for the purposes of this clause. Supplier remedies and resubmits, and the review period restarts for the resubmitted Deliverable only. A Deliverable neither accepted nor rejected within 10 business days is deemed accepted.

Deemed acceptance protects the supplier, and that is why it belongs in ACME's own template. Without it a client that simply goes quiet suspends payment indefinitely while the supplier carries the cost. ⚠ It also creates the obligation ACME is most likely to fail: C-04 in §6 is a real dependency with a named owner, and on this program the review window repeatedly falls during cutover, when the people qualified to review are the people running it.

6. Client Responsibilities and Dependencies

Supplier performance is conditional on ACME meeting the following. Failure of a Client Dependency does not entitle Supplier to additional payment except through an approved Change Order under §9, but may entitle Supplier to a schedule adjustment of no more than the period of the delay.

RefACME obligationACME ownerTiming
C-01Provide production-representative X12 test files across all transaction setsT. Osei-Bonsu, Senior EDI AnalystBefore DL-01
C-02Provide trading partner companion guides in forceL. Marchesi, Senior EDI AnalystBefore DL-02
C-03Make claims configuration decision-makers availableW. FerridayThroughout
C-04Accept or reject each Deliverable within the review period in §5.1W. FerridayPer submission

A dependency without a named owner and a date is a wish. These are the clauses a supplier cites when the program slips, and ACME cannot argue with them after the fact — which is precisely the reason to agree them before the work starts rather than once it is late.

7. Fees and Payment

⚠ Fee amounts are carried in the Program Budget and the Vendor Management Plan and are not restated here. What this section fixes is what triggers payment — the term that decides which party carries risk between milestones.

#Payment milestoneDeliverable% of SOW value
1Execution and mobilization10%
2Acceptance of DL-01DL-0117%
3Acceptance of DL-02DL-0217%
4Acceptance of DL-03DL-0317%
5Acceptance of DL-04DL-0417%
6Acceptance of DL-05DL-0517%
7Warranty exit and closeout5%

Payment falls due thirty days after Acceptance of the linked Deliverable under §5.1 — not on submission, and not on invoice.

The five per cent held to warranty exit is the point of this schedule. It is small enough to be uncontroversial at signature and disproportionately effective afterwards, because it keeps Supplier commercially engaged through the period when defects actually surface. A schedule that fully discharges at go-live removes Supplier's incentive at exactly the moment ACME first depends on the thing working.

8. Key Personnel and Service Levels

Supplier shall not replace personnel named as key without ACME's written consent, and shall provide a replacement of equivalent capability at its own cost where it does. Defect response runs to the levels below, measured from ACME's report.

LevelResponseResolutionDefinition
Severity 14 hours1 business dayBlocks a test cycle
Severity 21 business day3 business daysBlocks a transaction set
Severity 32 business days10 business daysWorkaround exists
Severity 45 business daysBy cycle endReporting or cosmetic

9. Change Orders

Any change to scope, Deliverables, Acceptance Criteria, service levels or fees takes effect only through a written Change Order executed by the same authorities that executed this Statement of Work under §17. Work performed without an executed Change Order is performed at Supplier's risk and is not payable.

The signature-parity requirement is the operative half of this clause. Scope creep on an integration program is rarely a decision; it is an accumulation of small agreements between people who each lacked authority to make them. Requiring the original signatories makes every increment visible to the person accountable for the commitment.

10. Warranty

RefProvision
WR-01Supplier warrants that delivered scope will perform in accordance with its Acceptance Criterion for 90 calendar days following Acceptance of the Deliverable concerned. ⚠ The period runs from Acceptance, not delivery — Vendor Management Plan §5, SW-01.
WR-02Defects reported during the Warranty Period are remediated at no additional charge, to the service levels in §8.
WR-03Attribution. Whether an item is a Defect (Supplier remediates) or a change (ACME pays) is determined against the Deliverable's Acceptance Criterion and the as-built documentation. Disputed items escalate under §12 and are classified as they arise, never batched to warranty exit.
WR-04Defects unresolved at warranty exit are recorded with an agreed remediation path. Warranty exit does not extinguish an unresolved Defect.
WR-05Remediation of a Defect re-starts the Warranty Period for the remediated component only.

WR-03 settles the predictable argument in advance. Every warranty period produces the same dispute: is this a defect you fix, or a change I pay for? Agreeing the classification basis at signature — when neither party knows which side of it they will be on — is worth more than any amount of goodwill negotiated later, once the answer has become financially consequential to someone.

11. Warranty, Support and Version Obligations

The obligations below are mandatory under Vendor Management Plan §5 and are not subject to negotiation on price. They govern the period after acceptance, which is where the cost of an incomplete statement of work is actually incurred.

RefTermProvision
SW-02Defect remediation service levelsResponse and resolution by severity, using ACME's severity definitions from the Quality Plan, not Supplier's. Severity 1 — a defect harming a member or breaching a regulatory obligation — carries a 1 hour response and continuous effort to resolution.
SW-08Environment coverage⚠ Support covers non-production environments. A test environment nobody will fix stops testing, which stops the program.
Supplier provides tooling rather than a licensed product, so warranty and version obligations are limited to defect remediation in that tooling and to test environment coverage.

12. Governance and Escalation

LevelForumACMEEscalates when
OperationalWeekly supplier check-in — individual, never jointW. FerridayDelivery, defects and dependencies in the ordinary course
ProgramIMO weeklyC. Tyrrell, Program ManagerA dependency or Defect threatens a program milestone
CommercialProcurement reviewH. Castellow, VP ProcurementFees, Change Orders, or performance against §8 service levels
ExecutiveIntegration Steering CommitteeD. Ashmore, CFO and SponsorTermination is contemplated, or a dispute is unresolved after thirty days

Suppliers are met individually and never together. A joint forum means discussing one supplier's delivery problems in front of another who may bid for the same work next year — and a supplier will not tell you its delivery lead has resigned with a competitor in the room. Cross-supplier dependencies are brokered through the program.

13. Limitation of Liability

Each party's aggregate liability arising out of or in connection with this Statement of Work is limited to the fees paid and payable under it in the twelve months preceding the event giving rise to the claim. Neither party is liable for indirect or consequential loss.

The following are excluded from that cap and are unlimited:

RefUncapped liability
LL-01Breach of confidentiality.
LL-02Any breach, loss or unauthorized disclosure of PHI, and any breach of the Business Associate Agreement at GC-06.
LL-03Indemnity against third-party claims that delivered scope infringes intellectual property rights.

The cap is a formula rather than a figure, and that matters on a program of this length. A cap fixed in dollars at signature stops tracking the exposure as the engagement grows; a rolling twelve-month cap moves with what Supplier is actually being paid. ⚠ The three carve-outs are the ones ACME cannot accept a cap on, because each can cost more than the whole instrument is worth — a PHI breach is priced by regulators and by the number of members affected, not by what the supplier was paid to prevent it.

14. Termination and Transition Assistance

RefProvision
TM-01For cause. Either party may terminate on written notice for material breach not remedied within 30 days of notice specifying the breach and what would remedy it. ⚠ Repeated breach of the same obligation is material whether or not each instance is.
TM-02For convenience. ACME may terminate on 60 days' written notice, paying for Deliverables accepted and work properly performed to the termination date and for no other amount. ⚠ Supplier holds no equivalent right during the TSA exit window.
TM-03Insolvency. Either party may terminate immediately on the other's insolvency, administration or equivalent process.
TM-04Transition assistance. On termination or expiry for any reason, Supplier provides transition assistance for up to 90 days at the rates then in effect — ACME data in an agreed format, as-built configuration documentation, and knowledge transfer to ACME or its nominee. This obligation survives termination, including termination by Supplier for ACME's breach.
TM-05No suspension for disputed sums. Supplier shall not suspend service or withhold transition assistance on account of a disputed invoice; disputes run through §12 escalation.

Transition assistance is negotiated now because it cannot be negotiated later. It is the term a client has least leverage to obtain at the moment it needs it — by then the relationship has usually failed and the supplier has no commercial reason to help. ⭐ Leverage is set by how long you still need someone, not by how long the relationship has left to run, and TM-05 exists because withholding help over a disputed invoice is the most common way this clause is defeated in practice.

15. Order of Precedence

Where documents conflict, the following order applies:

#Document
1The Master Services Agreement
2The Business Associate Agreement, in respect of PHI
3Executed Change Orders, most recent first
4This Statement of Work
5Vendor Management Plan §4 and §5, as reproduced here
6Supplier proposals and correspondence

Supplier proposals rank last deliberately. A proposal is written to win the work: it routinely contains commitments the supplier would not accept as contractual alongside assumptions ACME never agreed. Ranking it above this instrument would import both.

16. General Conditions

RefClauseProvision
GC-01Governing agreementThis statement of work is issued under the Master Services Agreement between ACME Health and Gallatin EDI Assurance. Where the two conflict, the Master Services Agreement governs except on scope, price and schedule, which this instrument governs.
GC-02Contracting party across the close⚠ Executed before closing by ACME Health. Cumberland Valley Health Plan becomes a beneficiary at closing without further action; no novation is required because ACME is the contracting party throughout.
GC-03Key personnelNamed individuals in §2 may not be substituted without written agreement. A substitution without agreement is a material failure, not an administrative change.
GC-04SubcontractingNo subcontracting without prior written consent. All obligations of this instrument flow down to any approved subcontractor, including data-handling and audit rights.
GC-05Data handling and location⚠ No member-level data is processed, stored or accessed outside the United States. This is a contractual obligation, not a policy preference, and derives from a condition of the state insurance approval.
GC-06Business associate agreementA business associate agreement is executed before any access to protected health information, and remains in force through the retention period after termination.
GC-07Security incident notificationSupplier notifies ACME within 24 hours of discovering a suspected security or privacy incident. ⚠ The clock runs from discovery, not from confirmation.
GC-08Audit rightsACME may audit compliance on 10 business days' notice, and without notice following a reported incident.
GC-09InsuranceProfessional liability, cyber liability and workers compensation maintained at the limits in the Master Services Agreement; certificates provided before work begins and on renewal.
GC-10Change controlScope changes are priced and approved before work begins, against the program's thresholds ($250,000 Program Manager, $1,000,000 Executive Sponsor, above that the Steering Committee). ⚠ Work performed before approval is performed at Supplier's risk.
GC-11Intellectual propertyTest cases, traceability and results are the property of ACME Health and are reusable for future trading partner onboarding.
GC-12Knowledge transferKnowledge transfer is a deliverable with named receivers and an acceptance test, not a by-product of the work. Acceptance is by reverse shadowing: ACME performs unaided while Supplier observes.
GC-13Termination for convenienceACME may terminate on 30 days' written notice. Supplier is paid for work accepted and work in progress to the termination date.
GC-14Transition assistance⚠ On termination for any reason, Supplier provides transition assistance for up to 90 days at the rates in §4, and returns all data and artifacts in a documented, usable format. "Available on request" is not a format.
GC-15Surviving obligationsConfidentiality, business associate terms, data return and record retention survive termination.
GC-16IndependenceSupplier confirms no engagement with Cumberland Valley Health Plan, Cheatham Mutual Holdings, or any party adverse to the transaction, and will disclose any such engagement arising during the term.

17. Execution

This statement of work is not effective until executed by an authorized signatory of both parties and endorsed by ACME Legal. ⚠ Work performed before execution is performed at Supplier's risk and is not payable.

For ACME Health
D. Ashmore
EVP & Chief Financial Officer · Executive Sponsor
Date: _______________
For Gallatin EDI Assurance
M. Everly
Managing Director · authorized signatory
Date: _______________
Procurement approval
H. Castellow
VP Procurement, ACME Health
Date: _______________
Four signatures rather than two, and each one is a different check. The business owner confirms the work is wanted and funded; the supplier's officer binds their firm; Procurement confirms the commercial terms match the framework agreement; Legal confirms the clauses that only matter later — data handling, liability, termination and the §5 obligations — are actually present. ⚠ The signature most often skipped under schedule pressure is the legal one, and it is the only one that reads the parts of the document nobody expects to need.

Related: 21A — Vendor Management Plan · 8 — Consulting SOW & Engagement Model · 21 — Vendor & Contract Disposition Matrix · 26 — Quality Plan