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2019-097B
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2019-097B
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Last modified
12/27/2019 1:35:44 PM
Creation date
7/23/2019 3:03:42 PM
Metadata
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Template:
Official Documents
Official Document Type
Miscellaneous
Approved Date
06/18/2019
Control Number
2019-097B
Agenda Item Number
8.K.
Entity Name
Johns Easter Company, Inc.
Subject
Third Party Claims Administration Services
Area
self funded Workers' Compensation and Liability Program
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4.20 Successors. This Agreement shall be binding upon and shall inure to the benefit of all <br />assigns, transferees and successors in interest of the Parties. <br />4.21 Assignment. Neither this Agreement nor any interest herein may be assigned, transferred or <br />encumbered by any party without the prior written consent of the other Party. <br />4.22 Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program) <br />Extension Act of 2007 ("MMSEA"). TPA acknowledges and agrees that IRC has an obligation to <br />perform Mandatory Insurer Reporting ("MIR") as set forth in Section 111 of the MMSEA. MMSEA <br />provided for mandatory reporting requirements for group health plan arrangements and for liability <br />insurance (including self-insurance), no-fault insurance, and workers' compensation (see 42 U.S.C. <br />1395y(b)(7) & (8)). IRC agrees to properly register with the Centers for Medicare and Medicaid <br />Services ("CMS") as the Responsible Reporting Entity ("RRE"), to provide to TPA all relevant <br />information including the RRE, Identification Number(s) assigned, and to properly designate a MIR <br />reporting agent acceptable to TPA. IRC agrees that for each and every claim reported to TPA in <br />which IRC possesses the information, TPA shall provide the following information as soon as <br />required to comply with applicable law and avoid fines and penalties: claimant's first and last name, <br />social security number, date of birth and gender. IRC consents to the disclosure of any required <br />information to TPA's designated third party for processing IRC's MIR. <br />4.23 Funds for Payment of Claims. IRC has the sole obligation and responsibility for funding the <br />payment of claims made by its employees in accordance with the Workers' Compensation Law as <br />adopted and amended by the State of Florida and the applicable rules and regulations as promulgated <br />by the applicable agencies of the State of Florida relating to the Workers' Compensation Law. TPA <br />assumes no duty to fund any such claims at any time and shall have no obligation to advance funds <br />for any such payment. IRC agrees to inform TPA of all relevant details with respect to any such <br />accounts in order to TPA to perform its duties under this Agreement. <br />TPA will analyze the account from time to time and will submit advisory reports, including any <br />deficiencies to the account. As a result of the advisories, the IRC agrees to fund any increase within <br />thirty (30) days of notification. <br />In the event of cancellation or nonrenewal of this Agreement, IRC agrees to fund an amount <br />sufficient to fund all of IRC's outstanding obligations as they become due. <br />If, at any time, IRC or its carrier fails to provide adequate funding, TPA may issue "stop payment" <br />orders on outstanding payments. Any bank charges resulting from inadequate funding including, but <br />not limited to, interest, stop payment charges and overdraft fees shall be the obligations of IRC and <br />shall be paid by IRC upon demand by TPA. <br />If IRC on more than one occasion fails to provide adequate funding, TPA shall have the right to <br />convert IRC's program to either daily clearance or voucher upon 48 hours notice to IRC. This right <br />Page 9 <br />
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