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
| Attribute | Provision |
|---|---|
| Client | ACME Health |
| Supplier | Gallatin EDI Assurance |
| Instrument | SOW-03, issued under the Master Services Agreement |
| Vendor register reference | VN-03 in the Vendor Management Plan |
| Vehicle | Fixed price, deliverable-based |
| ACME owner | W. Ferriday, VP Claims Operations |
| Effective | August 28, 2023 — ⚠ subject to execution under §7 |
| Term | From execution through core administration cutover acceptance. |
| Governing document | Vendor 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.
| Term | Meaning in this Statement of Work |
|---|---|
| Acceptance | Written confirmation by ACME that a Deliverable meets its stated Acceptance Criterion, or expiry of the review period in §5.1 without written rejection. |
| Acceptance Criterion | The objective, demonstrable condition stated against each Deliverable in §5. ⚠ A criterion that cannot be demonstrated is not a criterion. |
| Deliverable | An item Supplier is contractually obliged to produce under §5. |
| Defect | A 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 Dependency | An obligation of ACME under §6 on which Supplier performance depends. |
| Warranty Period | The 90 calendar days following Acceptance of the Deliverable concerned. ⚠ Not from delivery, and not from execution. |
| PHI | Protected health information as defined under HIPAA, in respect of which the Business Associate Agreement at GC-06 governs. |
| Change Order | A 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
| Ref | Element | Provision |
|---|---|---|
| SC-01 | 834 enrollment and maintenance | Full-file and change-file semantics per trading partner, effective dating, termination and reinstatement handling. |
| SC-02 | 837 claims | Institutional, professional and dental tested as separate rule sets, not as one format with options. |
| SC-03 | 835 remittance | Reconciled to the payment actually issued, across both paying platforms during coexistence. |
| SC-04 | 270/271 eligibility | Inquiry and response under load, including timeout and error behavior. |
| SC-05 | 820 premium payment | Reconciled against billing at group level. |
| SC-06 | Trading 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.
| Ref | Excluded | Where it sits instead |
|---|---|---|
| EX-01 | Interface build | Supplier assures transactions; it does not build the interfaces. |
| EX-02 | Trading partner contracting | Partner agreements remain ACME's. |
| EX-03 | Remediation of ACME defects | Supplier 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.
| Ref | Deliverable | Acceptance criterion |
|---|---|---|
| DL-01 | Test strategy and traceability | Every transaction set mapped to the business control that proves it |
| DL-02 | Executed test cycles per transaction set | ⚠ Acceptance is a business-level control total, not a 999 acknowledgment |
| DL-03 | Trading partner readiness register | Per partner, with evidence of a successful test exchange |
| DL-04 | Defect report with aging | Counts reported with age; a stable count with rising age is a backlog |
| DL-05 | Assurance opinion at cutover | Written 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.
| Ref | ACME obligation | ACME owner | Timing |
|---|---|---|---|
| C-01 | Provide production-representative X12 test files across all transaction sets | T. Osei-Bonsu, Senior EDI Analyst | Before DL-01 |
| C-02 | Provide trading partner companion guides in force | L. Marchesi, Senior EDI Analyst | Before DL-02 |
| C-03 | Make claims configuration decision-makers available | W. Ferriday | Throughout |
| C-04 | Accept or reject each Deliverable within the review period in §5.1 | W. Ferriday | Per 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 milestone | Deliverable | % of SOW value |
|---|---|---|---|
| 1 | Execution and mobilization | — | 10% |
| 2 | Acceptance of DL-01 | DL-01 | 17% |
| 3 | Acceptance of DL-02 | DL-02 | 17% |
| 4 | Acceptance of DL-03 | DL-03 | 17% |
| 5 | Acceptance of DL-04 | DL-04 | 17% |
| 6 | Acceptance of DL-05 | DL-05 | 17% |
| 7 | Warranty exit and closeout | — | 5% |
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.
| Level | Response | Resolution | Definition |
|---|---|---|---|
| Severity 1 | 4 hours | 1 business day | Blocks a test cycle |
| Severity 2 | 1 business day | 3 business days | Blocks a transaction set |
| Severity 3 | 2 business days | 10 business days | Workaround exists |
| Severity 4 | 5 business days | By cycle end | Reporting 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
| Ref | Provision |
|---|---|
| WR-01 | Supplier 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-02 | Defects reported during the Warranty Period are remediated at no additional charge, to the service levels in §8. |
| WR-03 | Attribution. 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-04 | Defects unresolved at warranty exit are recorded with an agreed remediation path. Warranty exit does not extinguish an unresolved Defect. |
| WR-05 | Remediation 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.
| Ref | Term | Provision |
|---|---|---|
| SW-02 | Defect remediation service levels | Response 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-08 | Environment coverage | ⚠ Support covers non-production environments. A test environment nobody will fix stops testing, which stops the program. |
12. Governance and Escalation
| Level | Forum | ACME | Escalates when |
|---|---|---|---|
| Operational | Weekly supplier check-in — individual, never joint | W. Ferriday | Delivery, defects and dependencies in the ordinary course |
| Program | IMO weekly | C. Tyrrell, Program Manager | A dependency or Defect threatens a program milestone |
| Commercial | Procurement review | H. Castellow, VP Procurement | Fees, Change Orders, or performance against §8 service levels |
| Executive | Integration Steering Committee | D. Ashmore, CFO and Sponsor | Termination 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:
| Ref | Uncapped liability |
|---|---|
| LL-01 | Breach of confidentiality. |
| LL-02 | Any breach, loss or unauthorized disclosure of PHI, and any breach of the Business Associate Agreement at GC-06. |
| LL-03 | Indemnity 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
| Ref | Provision |
|---|---|
| TM-01 | For 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-02 | For 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-03 | Insolvency. Either party may terminate immediately on the other's insolvency, administration or equivalent process. |
| TM-04 | Transition 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-05 | No 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 |
|---|---|
| 1 | The Master Services Agreement |
| 2 | The Business Associate Agreement, in respect of PHI |
| 3 | Executed Change Orders, most recent first |
| 4 | This Statement of Work |
| 5 | Vendor Management Plan §4 and §5, as reproduced here |
| 6 | Supplier 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
| Ref | Clause | Provision |
|---|---|---|
| GC-01 | Governing agreement | This 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-02 | Contracting 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-03 | Key personnel | Named individuals in §2 may not be substituted without written agreement. A substitution without agreement is a material failure, not an administrative change. |
| GC-04 | Subcontracting | No subcontracting without prior written consent. All obligations of this instrument flow down to any approved subcontractor, including data-handling and audit rights. |
| GC-05 | Data 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-06 | Business associate agreement | A business associate agreement is executed before any access to protected health information, and remains in force through the retention period after termination. |
| GC-07 | Security incident notification | Supplier notifies ACME within 24 hours of discovering a suspected security or privacy incident. ⚠ The clock runs from discovery, not from confirmation. |
| GC-08 | Audit rights | ACME may audit compliance on 10 business days' notice, and without notice following a reported incident. |
| GC-09 | Insurance | Professional liability, cyber liability and workers compensation maintained at the limits in the Master Services Agreement; certificates provided before work begins and on renewal. |
| GC-10 | Change control | Scope 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-11 | Intellectual property | Test cases, traceability and results are the property of ACME Health and are reusable for future trading partner onboarding. |
| GC-12 | Knowledge transfer | Knowledge 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-13 | Termination for convenience | ACME may terminate on 30 days' written notice. Supplier is paid for work accepted and work in progress to the termination date. |
| GC-14 | Transition 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-15 | Surviving obligations | Confidentiality, business associate terms, data return and record retention survive termination. |
| GC-16 | Independence | Supplier 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.
Related: 21A — Vendor Management Plan · 8 — Consulting SOW & Engagement Model · 21 — Vendor & Contract Disposition Matrix · 26 — Quality Plan