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R2007-236 AUTHORIZING AGREEMENT WITH BLUE CROSS BLUE SHIELD OF ILLINOIS
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R2007-236 AUTHORIZING AGREEMENT WITH BLUE CROSS BLUE SHIELD OF ILLINOIS
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10/23/2015 3:29:59 PM
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Res Ord Num
R2007-236
Res Ord Title
AUTHORIZING AGREEMENT WITH BLUE CROSS BLUE SHIELD OF ILLINOIS - ADMINISTRATIVE SERVICES AGREEMENT
Approved Date
12/26/2007
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� <br /> , . <br /> w <br /> . TABLE OF CONTENTS <br /> SECTION 26: SEVERABILI'I'1' . . ... . . . . ... . . . . .. .... . . . . . . .. . .. .. ... . .. . . ..... ... . . . . ... . . . . . . . . 16 <br /> SECT'ION 27: ENFORCEMENT .. ... . . . .. . . ... . . . .. . . . . . . . . . . . . . . ... . . . . . . .. . . . . . . . ... . . . . . . . ... 16 <br /> SECTION 28: FORCE MAJEURE . . .. . . . . . . . . .. . . . . . .. . . . . . . . . . . . . ... . . .. . . .... . . . . . . ... . . . . . . . . . 16 <br /> SECTTON 29: NOT'ICE OF ANNUAL MEETTNG . . . .. ... . . . . . . . . . . ... . . . . . . . . . ... . . . . . . . ... . . . ... . . 16 <br /> EXHIBI'I'1................................................................................... 17 <br /> CLAIM ADMINISTRATOR SERVICES . . ... . . . .. . .... .. . . . . .. . ... . . . . . . . . . . ... . . . ... ... . . . ... . . .. . 17 <br /> EXHIBIT2................................................................................... 19 <br /> FEE SCHEDULE,FINANCIAL RESPONSIBILITIES&REQUIRED DISCLOSURES .. . . . .. . ... . . . . ... . .. . 19 <br /> SECI'ION 1: FEE SCHEDULE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 <br /> SECI'ION 2: EXHIBIT DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 <br /> SECTION 3: COMPENSATION TO CLAIM ADMINISTRATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 <br /> SECTION 4: CLAIM PAYMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 <br /> SECITON 5: TRANSFER PAYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 <br /> SECITON 6: CLAIM SETTI,EMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 <br /> SECITON 7: LATE PAYMENTS AND REMEDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 <br /> SEC'TION 8: FINANCIAL OBLIGATIONS UPON AGREEMENT TERMINATION . . . . . . . . . . . . . . . . 23 <br /> SECTION 9: REQUIRED DISCLOSURE PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 <br />' SECTION 10: PAYMENT OF CLAIMS AND ASSIGNMENT OF BENEFITS: . . . . . . . . . . . . . . . . . . . . 24 <br /> SECT'ION 11: COVERED PERSON/PROVIDER RELA'TIONSHIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 <br /> SECTION 12: LIMITED BENEFITS FOR NON-NETWORK PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . 25 <br /> SECTION 13: CLAIM ADMINISTRATOR'S SEPARATE FINANCIAL ARRANGEMENTS <br /> WITH PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 <br /> SECTTON 14: BLUECARD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 <br /> SECTION 15: SERVICING PLAN AGREEMENTS BETWEEN CLAIM ADMINISTRATOR <br /> AND OTHER BLUE CROSS AND BLUE SHIELD PLANS . . . . . . . . . . . . . . . . . . . . . . . . 27 <br /> SECTION 16: MEDICARE SECONDARY PAYER("MSP")DATA MATCH . . . . . . . . . . . . . . . . . . . . . . 28 <br /> HCSC IL ASA Rev.6/07 -3- <br />
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