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2018-015A1
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Last modified
12/21/2020 11:37:35 AM
Creation date
5/9/2018 1:10:52 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
01/23/2018
Control Number
2018-015A1
Agenda Item Number
12.D.1.
Entity Name
RxBenefits
Subject
Administrative Services Agreement for Prescription Benefits
Alternate Name
Health Insurance Drug Benefits
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will be provided to Client upon request therefor). Client agrees that it will execute (and shall cause <br />any mutually acceptable independent, third party auditor taking part in any such audit to execute) a <br />confidentiality agreement in form and content reasonably acceptable to Administrator and PBM <br />prior to conducting any such audit, so long as such agreement is consistent with law. Any request <br />by Client to permit an auditor to perform an audit will constitute Client's direction and authorization <br />to Administrator and PBM to disclose PHI to auditor. In the event of an audit by a mutually <br />acceptable independent third party, Administrator and Client shall be provided with a copy of any <br />proposed audit report or other written materials documenting such audit and Administrator will have <br />a reasonable opportunity to comment on any such report or written materials documenting such <br />audit before such are finalized. Upon finalization of audit results and agreement between Client and <br />Administrator on any identified adjustments or discrepancies, if any, the period under review will <br />be considered closed by the Parties and such agreed upon adjustment payments, if any, shall be paid <br />by the appropriate party within thirty (30) days of execution by the Parties of an appropriate release <br />document covering the audit period. Client acknowledges that it shall not be entitled to audit <br />documents that Administrator is barred from disclosing by applicable law or pursuant to an <br />obligation of confidentiality to a third party or that are not under the direction or control of <br />Administrator. Administrator will make 100% of claims available to the Client or a mutually <br />acceptable third party retained by Client to audit the processing contract. <br />3. Client acknowledges that government agencies may seek eligibility or similar data from <br />Administrator or PBM regarding Members and may submit to Administrator or PBM claims for <br />reimbursement for prescription drug benefits provided to such government agencies (or their agents) <br />to Members ("Government Claims"), Administrator authorizes Administrator and PBM to provide <br />such data as requested by government agencies or their authorized agents and further authorizes <br />Administrator and/or PBM to process such Government Claims. Client acknowledges that <br />Administrator may advance payment for Government Claims on behalf of Client. Client shall <br />reimburse Administrator, in accordance with Client's payment obligations under this Agreement, <br />for all amounts advanced by Administrator for payment of Government Claims. Client <br />acknowledges that Government Claims submitted by or on behalf of a state Medicaid Agency shall <br />be paid if submitted within three (3) years from the original date of fill unless a longer period is <br />required by applicable law. In addition, Government Claims submitted by or on behalf of a state <br />Medicaid agency may not be denied on the basis of the format of the Government Claim or failure <br />to present proper documentation at the point-of-sale. Client shall also reimburse Administrator for <br />any adjustments or reconciliations to previously processed Government Claims that may be payable <br />to government agencies in accordance with applicable laws and regulations. The administrative fee <br />for processing Government Claims shall be invoiced at the paper submitted claim rate already <br />agreed to by the Parties or as otherwise agreed upon in writing by Administrator and Client. <br />Administrator reserves the right to (a) terminate these services upon ninety (90) days prior notice to <br />Client, or (b) delegate these services to a third party claims processor other than PBM. <br />I. Confidential and Proprietary Information. <br />1. The term "Confidential Information" includes, but is not limited to, this Agreement or any <br />information of either Client or Administrator (including without limitation its designees) (whether <br />oral, written, electronic, visual or fixed in any tangible medium of expression) relating to either <br />party's services, operations, systems, programs, inventions, techniques, suppliers, customers and <br />prospective customers, contractors, costs and pricing data, trade secrets, know-how, processes, <br />plans, designs and other information of or relating to either party's business. Confidential <br />Information does not include Protected Health Information, the use and disclosure of which is <br />governed by Article IX.0 (including Exhibit B) of this Agreement. <br />2. Unless otherwise provided by law and subject to Section IIID) herein, Administrator and Client <br />shall not disclose or make use of any Confidential Information except as permitted under this <br />Agreement without the prior written consent of the non -disclosing party, which consent may be <br />conditioned upon the execution of a confidentiality agreement. Each party may disclose <br />Confidential Information of the other party only to its authorized Representatives who have a need <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />15 <br />
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