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MEDICARE REPORTING SERVICES SCHEDULE To assist the Client in fulfilling Client's Medicare beneficiary reporting obligations under Medicare, Medicaid and State Children's Health Insurance Program Extension Act of 2007 ("MMSEA") Section 111 as set forth in 42 L.S.C. § I 395y(b)(7)&(8) and the CVIS user Guide ("User Guide") published on March 16, 2009 (and as amended and revised), Sedgwick will perform the following reporting services: Sedgwick will electronically interface with the Centers for Medicare and _Medicaid Services ("CMS") to capture and report data in the format prescribed by the CMS Specifications. 2. Sedgwick will report directly to CMS on behalf of Client as an Account Designee (reporting agent), as such term is defined in the CMS User Guide as amended from time to time by CVIS. 3. Client will be considered a Responsible Reporting Entity ("RRE") as that term is defined in the User Guide. a. Client will be responsible for maintaining a valid RRE Identification Number as described in the user Guide and is a condition precedent to Sedgwick preforming the duties under this section. Failure to maintain the RRE Identification Number will result in Sedgwick's inability to properly report claims on behalf of the Client. Sedgwick assumes no responsibility for maintaining a valid RRE Identification Number on behalf of the Client. 4. Sedgwick will assist Client as follows: a. Sedgwick will electronically interface with the Centers for Medicare and Medicaid Services ("CMS") to capture and report data in the format prescribed by the User Guide. b. Sedgwick will report directly to C'_VIS on behalf of the Client as an Account Designee (reporting agent), and/or Account Manager as such term is defined in the User Guide. c. Sedgwick will prepare the required data files and submit them to CMS on a periodic basis in order to properly query and report the appropriate files as defined in the User Guide. Sedgwick will be responsible for payment of any and all fines assessed to Client regarding compliance with the Medicare beneficiary reporting requirements of Medicare, Medicaid and SCHIP Extension Act of 2007 that relate to the negligent acts or omissions of Sedgwick except to the extent that: a. Such fines or penalties are the direct result of specific direction given by Client and/or its agent or the actions or omissions of Client and/or its agent; or b. Sedgwick did not receive information from Client that is essential to the performance of the duties set forth herein in a timely manner so as to be able to comply with the terms of this Agreement. C/20912 25