Claims Responsibility. The parties understand and agree that under state and/or federal statutes and regulations governing insurers, HMOs and claims turnaround times/payment procedures, Plan may be required to pay any due and outstanding Claims even in the event that amounts then in the Claims Payment Account are unavailable to Plan and/or insufficient to pay such Claims, putting Plan at risk for Claims responsibility contrary to the intent of this Agreement. In the event Plan is required to make Claims payments under the circumstances described in this subsection 6, BJC agrees that to the extent the funds necessary to pay the Claims were not directly and timely available to HCUSA under the BJC ILOC, then , BJC shall hold harmless and indemnify Plan for any and all payments, losses, claims, liabilities, actions, suits, causes of action, administrative or regulatory proceedings, costs and expenses arising out of or related to such Claims payments. In addition, BJC shall assure that BJC Providers do not bill xxx BJC Medicaid Member for Covered Services if BJC Provider fails to submit claims in accordance with the terms and conditions set forth in this Agreement (including without limitation this and any other applicable Exhibits, appendices, addendums or attachments), and BJC shall indemnify and hold harmless Plan and BJC Medicaid Member and the Missouri Department of Medical Services for all payments, losses, liabilities, claims, suits, actions, causes of action, costs and expenses incurred by Plan and BJC Medicaid Member arising out of BJC Providers' failure to comply with the prohibition on billing contained in this Agreement, including without limitation this and any other Exhibits, appendices or attachments.
Claims Responsibility. The parties understand and agree that under state and/or federal statutes and regulations governing insurers, HMOs and claims turnaround times/payment procedures, Plan may be required to pay any due and outstanding Claims even in the event that amounts then in the Claims Payment Account are unavailable to Plan and/or insufficient to pay such Claims, putting Plan at risk for Claims responsibility contrary to the intent of this Agreement. In the event Plan is required to make Claims payments under the circumstances described in this subsection 6, BJC agrees that to the extent the funds necessary to pay the Claims were not directly and timely available to GHP under the BJC ILOC, then, BJC shall hold harmless and indemnify Plan for any and all payments, losses, claims, liabilities, actions, suits, causes of action, administrative or regulatory proceedings, costs and expenses arising out of or related to such Claims payments. In addition, BJC shall assure that BJC Providers do not bill xxx BJC Medicare
Claims Responsibility. Security Benefit will process initial reimbursement claims under the Medical Care and/or Dependent Care Flexible Spending Accounts, as applicable, in a non-discretionary and ministerial manner, using reimbursement guidelines established in accordance with the Cafeteria Plan Requirements and the Employee Retirement Income Security Act of 1974, as amended, to the extent applicable to the Plan. The Plan Administrator or its appointed claims fiduciary(ies) will have the ultimate right and responsibility to review any appeal of a contested initial benefit claim determination made by Security Benefit. Security Benefit may seek guidance from the Plan Administrator or its appointed claims fiduciary(ies) with respect to the processing of any claim that does not fit squarely within such guidelines. Any departure specifically requested by the Employer in writing with respect to Security Benefit’s routine claims determination procedures will be implemented by Security Benefit; provided, however, that if Security Benefit objects to the departure as inconsistent with the requirements of applicable law and Security Benefit reimbursement guidelines, the Employer will be solely liable for any increased compliance costs or expenses, penalties or fines, and/or other losses experienced by Security Benefit, the Employer, the Plan Administrator, participants and/or the Plan in connection with such requested departure.
