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1996-242
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1996-242
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Last modified
3/27/2018 3:14:08 PM
Creation date
9/1/2017 12:23:23 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
10/01/1996
Control Number
1996-242
Entity Name
Blue Cross and Blue Shield of Florida, Inc.
Subject
Group Health Plan
Alternate Name
Administrative Services Agreement
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r <br />3.3 Claims Processing. <br />The Administrator shall provide claims processing services on behalf of the <br />Employer for all properly submitted claims, in accordance with the benefits <br />set forth in Exhibit "A", using funds solely supplied by the Employer, as set <br />forth in Exhibit "B". The Administrator shall furnish each claimant with an <br />explanation of each claim that is paid, rejected or suspended. <br />For purposes of this Agreement, the term "claim(s)" shall be defined as the <br />amount paid or payable by the Administrator to providers of services and/or <br />covered group members under this Agreement and the Group Health Plan, <br />and in conformity with any agreements the Administrator enters into with <br />such providers of services. <br />3.4 Program Administration. <br />The Administrator shall administer its established Cost Containment <br />Program and Utilization Benefits Management Programs, as selected by the <br />Employer and outlined in the Group Health Plan. <br />The Administrator shall make available its Preferred Provider Organization <br />Program(s) to covered group members and their covered dependents, as <br />set forth in the Group Health Plan. Any agreements between providers of <br />services and the Administrator are the sole property of the Administrator <br />and the Administrator retains the right to the use and control thereof. <br />3.5 Overpayments. <br />Whenever the Administrator becomes aware of an overpayment under the <br />Group Health Plan, the Administrator shall make a diligent attempt to <br />recover such overpayment. In the event any part of an overpayment is <br />recovered, the Employer will receive a refund from the Administrator. The <br />Administrator shall notify the Employer whenever attempted recovery is <br />unsuccessful and the Administrator shall not be required to institute any <br />legal proceeding to recover such overpayment. <br />3.6 Records and Reports. <br />The Administrator agrees to establish, maintain and provide to the <br />Employer, records and reports generated as a result of the administration of <br />the Group Health Plan for the purposes of reporting claims experience and <br />conducting audits of operations. However, the Administrator will not provide <br />any report which contains individual group member identifiable medical <br />information, nor will the Administrator provide any information with regard to <br />960904.1 5 <br />
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