R2000-207 AUTHORIZING APPLICATIONS

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Any sums due the Claim Administrator will be paid by the Employer within ten (10) days from the date the Claim Administrator notifies the Employer. C. If, within the Claim Settlement Period, the Transfer Payments exceed the Claim Settlement Total, the Claim Administrator may, at its option, pay such difference to the Employer, apply the difference against amounts then owed the Claim Administrator by the Employer or autho- rize a reduction equal to such difference from the next Claim Settlement due the Claim Admin- istrator from the Employer. X. CLAIM PAYMENTS, NET CLAIM PAYMENTS, AUDITS AND CORRECTIONS OF ERRORS I A. Upon receipt of a Claim,the Claim Administrator will make a Claim Payment provided that all ', payments due the Claim Administrator under the terms of the Agreement are paid when due, and provided further,that the Employer performs all of its other obligations under the Agree- ment. � B. Any reasonable determination by the Claim Administrator in adjudicating a Claim under the ' Agreement that a Covered Person is entitled to a Net Claim Payment is conclusive evidence �, of the liability of the Employerto the Claim Administrator for such Net Claim Payment pursuant '� to section above entitled "Claim Settlements." I C. During the term of the Agreement and within one hundred eighty(180)days after the termina- 'i tion of the Agreement,the Employer may, upon at least thirty (30) days prior written notice to 'I the Claim Administrator, conduct reasonable audits of the Claim Administrator's records in re- gard to Claim Payments and Net Claim Payments calculated on the basis of Claim Payments I� made underthe Agreement.All such audits shall be subjectto the Claim Administrator's exter- �I nal review procedures and guidelines,a copy of whick�shall be furnished to the Employer upon written request to the Claim Administrator. D. Any errors identified in Claim Payments and Net Claim Payments will be promptly corrected by the Claim Administrator subject to the terms and conditions of the Agreement. The Em- ployer will assist and cooperate with the Claim Administrator in recovering errors in benefit payments made to Covered Persons but the responsibility for such errors in Claim Payments and Net Claim Payments calculated on the basis of Claim Payments shall ultimately be the Claim Administrator's, limited to the Claim Administrator's making an equitable adjustment to the Employer's account. However, the Claim Administrator shall be responsible only for the correction of e�rors identified in specific Claim Payments and Net Claim Payments and shall not be responsible for errors calculated to exist in a population of Claim Payments and Net Claim Payments on the basis of a sample drawn from that population. Further, the Claim Administrator has the right to implement reasonable administrative practices in the adminis- tration of the Agreement. Minor deviations in Claim Payments and Net Claim Payments from the provisions of the Agreement as a result of such reasonable administrative practices shall not be considered errors. E. During the term of the Agreement and within one hundred eighty(180)days after the termina- tion of the Agreement,the Claim Administrator may, upon at least thirty(30)days prior written notice to the Employer, conduct reasonable audits of Employer's membership records with respect to eligibility. XI. PAYMENT OF CLAIMS AND ASSIGNMENT OF BENEFITS - A. All payments by the Claim Administrator for the benefit of any Covered Person may be made directly to any Provider furnishing Covered Services for which such payment is due, and the Claim Administrator is authorized by such Covered Person to make such payments directly to such Providers. However, the Claim Administrator reserves the right in its sole discretion to pay any benefitsthat are payable under the terms ofthis Plan directly to the Covered Person - 6 - �