Contract between the board of regents of the unversity system of georgia and
GENERAL CONTRACTOR RESPONSIBILITIES
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- 4.2.1 Format.
- Change by Subcontractor.
- Section 37, Cover Remedy
- 4.10 Data Reporting.
- 4.13 Use of Names/Trademarks/Logos for Marketing Purposes.
- SPECIFIC CONTRACTOR RESPONSIBILITIES Contractor shall perform and complete the following task, obligations, and responsibilities: 5.1
- Attachment I, Performance Guarantees
- 5.1.1 Cost of System Development.
- 5.1.3 Daily Processing.
- 5.1.6 Retroactive Additions or Deletions.
4. GENERAL CONTRACTOR RESPONSIBILITIES4.1 Legal Compliance. As of the Effective Date of this Contract, and at all times throughout the term of this Contract, Contractor shall be and remain in compliance with all the applicable federal, State, and local laws, and all rules and regulations of the BOR, as well as any of the terms and conditions of this Contract. 4.2 Eligibility Submission. Contractor shall comply with the provisions of the Plans’ eligibility and enrollment requirements as outlined in the Award. The BOR shall determine eligibility for the respective Plans. Contractor agrees to accept, in BOR format, the weekly electronic file updates with eligible Members. Full eligibility files will be submitted to Contractor on a quarterly basis. 4.2.1 Format. The BOR format will be in compliance with the Health Insurance Portability and Accountability Act of 1996 as amended from time to time (HIPAA). 4.2.2 Retroactive Additions/Deletions. Contractor agrees to accept retroactive additions/deletions of at least ninety (90) days and collect and reconcile claim payments made in error. 4.3 Administration. Contractor shall be responsible for the administration of the MSA INO Plan. Contractor shall maintain formal contracts with all Providers that address the level of reimbursement, provider access, quality requirements and other key factors. 4.4 Changes by Contractor. Contractor shall immediately notify the BOR of any of the following changes:
(e) Change in corporate officers, executive employees, or corporate structure; (f) Material change in ownership (i.e. 5% or more); (g) Change in federal employee identification number or federal tax identification number; or (h) Change in the long-term credit rating or short-term credit rating as measured by Standard & Poor’s Rating Service.
(a) Change its corporate status or nature; or (b) Sell, transfer, convey, or assign more than a ten percent (10%) ownership interest to another entity. Contractor shall give the BOR not less than sixty (60) Calendar Days prior written notice of any event under this Section 4.4. Should the BOR not consent to any of these actions and Contractor desires to proceed with such action, then the BOR may, at its sole discretion, elect to terminate this Contract at such date as selected by the BOR. In such case, Contractor shall be responsible for the provisions of a Cover Remedy as outlined more specifically in Section 37, Cover Remedy of this Contract.
4.8 Evidence of Coverage. Contractor will provide the Evidence of Coverage summarizing benefit coverage for each Member in a form approved by the BOR. 4.9 Eligibility Verification. Contractor shall require that Providers verify a Member's eligibility under the MSA INO Plan by contacting the number listed on the Identification Card, unless otherwise authorized by the MSA INO Plan. Contractor shall require Providers to make diligent good faith efforts to verify the identity of the person presenting the Identification Card as the Member named thereon. 4.10 Data Reporting. Contractor agrees to provide data reports in accordance with the requirements in the Performance Guarantees in Attachment I and as mutually agreed during Implementation. 4.11 Performance Guarantees. Contractor agrees to provide reporting on the specific Performance Guarantees outlined in Attachment I. Continued failure to meet these goals will be considered a cause for termination of the Contract. 4.12 Monthly Premium Payments. Contractor shall accept, as payment in full for its services under this Contract, the Monthly Premium Payments. Contractor agrees that the execution of this Contract neither expresses nor implies that any particular volume of Employees will select the Plan Options. 4.13 Use of Names/Trademarks/Logos for Marketing Purposes. Contractor may use the names, trademarks and/or logos of the BOR and the Plan for the limited purpose of informing Members of the MSA INO Plan. Contractor shall obtain the written approval of the BOR prior to the distribution or release of the MSA INO Plan collateral materials.
Contractor shall perform and complete the following task, obligations, and responsibilities: 5.1 Eligibility Submission. Contractor shall comply with the provisions of the MSA INO Plan’s eligibility and enrollment requirements and the requirements outlined in Attachment I, Performance Guarantees. The BOR shall solely determine eligibility for the MSA INO Plan. Contractor shall accept all eligibility files in the BOR format, including the monthly full file and the nightly electronic file updates identifying Members. The nightly file updates include only additions, deletions and changes to the Membership records. 5.1.1 Cost of System Development. Contractor shall pay any costs associated with any Systems development and testing necessary to accept BOR formatted eligibility files. 5.1.2 Existing Systems Capability. Contractor shall use Connect: Direct and secure File Transfer Protocol (FTP), and shall update or replace these systems at its own costs for current use, and as the BOR requires in the future. 5.1.3 Daily Processing. Contractor shall accept and process eligibility loads each Calendar Day of the year; and shall stop an eligibility upload in the event that established error thresholds (agreed upon by Contractor and BOR) are exceeded. 5.1.5 BOR Staff Access. Contractor shall provide to the BOR staff view-only access to the MSA INO Plan’s eligibility data contained on its Systems. Contractor will provide training for the on-line tool and ongoing support for the BOR. 5.1.6 Retroactive Additions or Deletions. Contractor agrees to accept retroactive additions and deletions of at least one hundred eighty (180) Calendar Days and collect and reconcile claim payments made in error. 5.2 Account Services. Account services are set forth in Section 14, Contractor Staffing. 5.3 Plan Documents. During Implementation, Contractor shall provide the BOR all provider manuals, a draft Evidence of Coverage (EOC), and other documents that describe how claims are to be paid and wellness incentives are to be awarded in accordance with the BOR’s proposed plan design and wellness program. Contractor shall provide MSA INO Plan documents to Members in accordance with the Implementation Plan. Contractor shall provide the MSA INO Plan EOC documents and Part D Wrap Certificate to the BOR for review and approval, rejection, or modification within ninety (90) Calendar Days of the Effective Date. Thereafter, the Evidence of Coverage documents and Annual Notice of Changes documents shall be provided to the BOR for review and approval, rejection or modification at least ninety (90) Calendar Days prior to publication and distribution each calendar year. 5.4 Eligibility Verification by Network Providers. Contractor shall encourage Network Providers to verify the Member’s eligibility under the MSA INO Plan by contacting the number listed on the Member Identification Card, unless otherwise authorized by the BOR. Contractor shall encourage Network Providers to make diligent good faith efforts to verify the identity of the person presenting the Member ID Card as the Member named thereon.
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