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2015-025D
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2015-025D
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Last modified
4/2/2018 3:40:21 PM
Creation date
4/26/2016 11:52:47 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
02/17/2015
Control Number
2015-025D
Agenda Item Number
8.G.
Entity Name
Blue Cross and Blue Shield of Florida
Subject
Administrative Services Agreement
Financial Arrangements
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Shield Association, an association of independent Blue Cross and Blue Shield Plans, (the <br />"Association") permitting us to use the Blue Cross and Blue Shield Service Mark in the state of <br />Florida and that we are not contracting as the agent of the Association. You further acknowledge <br />and agree that you have not entered into this contract based upon representations by any person <br />other than us and that no person, entity, or organization other than us shall be held accountable or <br />liable to you for any of our obligations created under this Agreement. This paragraph shall not <br />create any additional obligations whatsoever on our part other than those obligations created <br />under other provisions of this Agreement. <br />O. Third Party Beneficiary <br />This Agreement was entered into solely and specifically for the benefit of Florida Blue and the <br />Group. The terms and provisions of the Agreement shall be binding solely upon, and inure solely <br />to the benefit of, Florida Blue and the Group, and no other person shall have any rights, interest <br />or claims under this Agreement, including the Evidence of Coverage, or be entitled to sue for a <br />breach thereof as a third -party beneficiary or otherwise. Florida Blue and the Group hereby <br />specifically express their intent that health care providers that have not entered into contracts <br />with Florida Blue to participate in Florida Blue's provider networks shall not be third -party <br />beneficiaries under this Agreement, including the Evidence of Coverage. <br />P. Inspection and Audit <br />You shall permit CMS, The U.S. Department of Health and Human Services, the Comptroller <br />General, or their designees, to inspect, evaluate, and audit any of your books, contracts, medical <br />records, patient care documentation, documents, papers, and other records pertaining to coverage <br />by providing records to Florida Blue, which will submit the records to CMS. This right to <br />inspect, evaluate, and audit shall extend ten (10) years from the expiration or termination of the <br />Agreement or completion of final audit, whichever is later, unless otherwise required by <br />applicable law. <br />Q. Benefit Administrator Guide <br />We will provide you with a Benefit Administrator Guide, which provides details related to how <br />your plan is administered and your responsibilities as a benefit administrator. <br />R. Member Communications and Campaigns <br />We may send CMS required or Florida Blue member communications without your consent. <br />Samples of all required materials are available upon request for informational purposes. <br />We may also contact Covered Persons by telephone regarding any Florida Blue campaign and <br />any campaign approved by the Florida Office of Insurance Regulation and/or CMS, as <br />applicable. We will notify you of the campaign prior to making contact with members. <br />12 <br />
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