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CONTRACT NO.
ADDENDUM TO ADMINISTRATIVE SERVICE AGREEMENT
This Addendum shall be attached to and made a part of the Administrative Service
Agreement between City of Fort Worth("Client") and CMI Barron Risk Management
Services, Inc. ("Barron")that was effective as of May 22,2001 (the"Agreement"), and is
entered into by and between Client and Sedgwick Claims Management Services, Inc.
("Sedgwick CMS") as of September 01, 2007.
As part of an acquisition, Sedgwick CMS is successor in interest to Barron with respect
to its rights and obligations under the Agreement. Pursuant to the above-referenced
acquisition,Barron has assigned to Sedgwick CMS all service obligations and rights
under the Agreement. Client acknowledges that Sedgwick CMS shall be providing
service to Client pursuant to the terms of this Addendum and to the Agreement, and
Client consents to such assignment.
The attached Authorization to Use a Voluntary Network in Texas is hereby incorporated
by reference.
All terms and conditions of the Agreement shall otherwise remain the same, except those
terms and conditions which have been added,deleted,or modified by the parties in
writing.
IN WITNESS WHEREOF,the parties have caused this Addendum to be executed on the
dates shown below.
City of Fort Worth Sedgwick Claims Management Services, Inc.
By By
aren L. Montgomery ` t
Title Assistant City Manager:CFO Title
Date Q 1"? Date a i 1 (01
Approved as to Fors:
l �"' Attested By:
Maleshia Farmer
Title Assistant City Attorney '
n�� �A
Date Marty Hcndri:x
Citv Secretary
Recommend Apprav t
By11�46A412s_ „/�/2 L -- --
( � ENCOEM��&C adl: UIRKaren arsh 1w„M, ED
Title Director of Hliman Resources
Date Q (�
Authorization to Use a Voluntary Network
Sedgwick CMS,through Barron, created SouthWest Medical Providers Network
("SWMPN")to contract with healthcare providers in Texas to make the services of these
contracted healthcare providers available to various employers and carriers(collectively,
"Payors")at the specified rates and fee schedules within healthcare provider agreements.
Client desires to authorize SWMPN to act as a third party agent on Client's behalf to
contract with healthcare providers for contract payment rates for which medical services
are to be reimbursed. SWMPN has entered into,or will enter into,such contractual
payment arrangements which identify,or will identify,SWMPN as an agent acting for
and on behalf of its Payors.
The parties agree as follows:
1. This Authorization is entered into for the purpose of complying with Texas
Department of Insurance Commissioner's Bulletin NO. B-0005-06 and
HB483.
2. Client hereby authorizes SWMPN to act as a third party agent to enter into
arrangements, either directly or indirectly, with physicians,health care
professionals,hospitals,and other healthcare providers on its behalf for
contractual rates at which medical services are to be reimbursed.
3. SWMPN will notify each contracted healthcare provider in the manner
SWMPN determines to be most feasible that SWMPN is authorized to
contract on behalf of Client and that the contract payment arrangements made
between the healthcare provider and SWMPN are on Client's behalf.
4. Client shall pay for the services provided by SWMPN off of the affected
claim files as an allocated loss adjustment expense. The fee for SWMPN's
services shall be 27%of savings.
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