Upon execution of the Contract, the CONTRACTOR shall initiate action that shall enable and ensure the smooth transition of all current claims between the CONTRACTOR and COUNTY. Included in the transition, but not limited to, is the following: a. Migration of all existing claims 1. All data from previous agency provider must be inputted into the CONTRACTOR’s database and verified. b. Provide quarterly updates to Palm Beach County Fire Rescue inclusive of all non-identifying information for all claims. c. Ability to process appeals d. Ability to produce required reports; e. Ability to access and resume service on previously submitted claims The above transition must be completed by 3/1/2026, if an extension is needed, a written request from the Contractor shall be submitted and both parties must agree. The CONTRACTOR shall not receive compensation for this transition and shall be limited to the fees provided in Appendix A, Price Proposal Pages. 4.3 PAYMENT/REFUND SERVICES 4.3.1 Electronic Claims Submission - The CONTRACTOR must provide the capability to submit claims electronically. 4.3.2 Claimant Information - The CONTRACTOR must take action to obtain any necessary information which may not be in the initial account file no later than 15 business day after initial submission. Thereafter, it is the claimant’s responsibility to comply and provide the request information. 4.3.3 Claim Review - The CONTRACTOR shall include a defined appeals process for claimants to follow if claims are rejected/denied. 4.3.4 Timely Reimbursements - The CONTRACTOR shall be expected to reimburse the Claimant within 30 days upon approved claim. 4.3.5 Payment Type - The CONTRACTOR shall be expected to provide payment by electronic transfers and/or checks, based on the Claimants preference. 4.3.6 Loss of Payment - In any case of a lost check, the claimant shall have the ability to request a new check, whereas the CONTRACTOR is responsible for cancelling the lost check. 4.3.7 Refunds - The CONTRACTOR must establish a systematic plan for determining over-payments and/or under-payments to claimants and shall be resolved no later than 90 days.
