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2016-137
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2016-137
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Last modified
9/16/2016 11:37:49 AM
Creation date
9/16/2016 11:37:46 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/13/2016
Control Number
2016-137
Agenda Item Number
8.V.
Entity Name
Johns Eastern Company Inc.
Subject
Third Party Administration Services
Self Funded Worker's Compensation and Liability
Project Number
UPC 3228
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ATTACHMENT B <br /> THIRD PARTY LIABILITY CLAIMS ADMINISTRATION <br /> SCOPE OF SERVICES <br /> ADMINISTRATIVE SERVICES <br /> TPA will provide the following administrative services: <br /> 1. Prepare (with IRC's assistance) and file with the appropriate state agencies all applications, <br /> bonds, documentation, and data required (if any) for implementation and continuance of the <br /> program. <br /> 2. Prepare, maintain, and file all records and reports as may be required by legal authorities(state, <br /> local,and federal)including Form 1099 and all reporting required for Medicare Secondary Payor <br /> provisions. <br /> 3. Prepare, maintain, and file statistical or other records and reports as required by IRC's excess <br /> insurers. <br /> 4. Prepare,maintain,and file statistical information required by Rating Bureaus or appropriate state <br /> agencies. <br /> 5. Comply fully with all rules, regulations, guidelines or procedures established by IRC and the <br /> State of Florida. <br /> CLAIMS SERVICES <br /> TPA will provide the following claims services: <br /> 1. Establish reporting procedures which are compatible with the needs and organizational structure <br /> of IRC. <br /> 2. Provide necessary forms and instructions for use. <br /> 3. Be available on a 24 hour basis,and provide immediate response to claims investigation requests <br /> through use of email or cellular telephones. <br /> 4. Provide a toll-free customer service line for employees. <br /> 5. Prepare and follow a work plan that has been approved by IRC in the handling of IRC's claims. <br /> Prepare and follow a work plan that has been approved by IRC in the handling of IRC's <br /> catastrophe claims. <br /> Page 19 <br />
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