1986-07-28 Regular Meeting - Laserfiche WebLink

Browse Search

e e ~..... EXHIBIT A ADMINISTRATIVE SERVICES I. Answer all telephone and mail inquiries from participants regarding benefits provided to them and their dependents. 2. Provide information concerning the plan benefits and eligibility of participants to all providers and participants based on eligibility information provided by the Plan Sponsor. 3. Receive claims and claim documents from the participants of the plan and verify the eligibility of the claimants for benefits based on eligibility information provided by the Plan Sponsor. 4. Review all claims thoroughly and coordinate them with doctors, hospitals, and other providers of services, to determine that the charges made are usual, reasonable and customary and/or related to diagnostic related groups, preferred provider organization agreements or other industry standards. 5. Correspond with claimants if additional information is needed for payment of their claims. 6. Coordinate benefits through the employee for potential payments from other benefit plans, insurance plans, health maintenance organizations and government sponsored plans. 7. Handle all claims expeditiously. 8. Process, issue and distribute the explanations of benefits and checks or drafts to the participants, hospitals, doctors, Plan Sponsor, or others as applicable, and provide documents to support these disbursements. 9. Furnish standard Administrator's internal forms and coordinate with the Plan Sponsor the design and printing of claim forms, ID cards, and other supplies designed specifically for the Plan Sponsor. 10. Notify claimants in writing of ineligible claims filed, explaining why a particular claim is ineligible for payment. 11. Provide the following claims reports: A. Explanation of benefits B. Claim analysis by line of coverage and total C. Claim list by participant D. Coordination of benefits savings E. Incurred claim lag study F. Claims pending reports G.. Cash transaction register H. Report to IRS regarding payment to health providers 12. Provide the necessary data to the Plan Sponsor for preparation of ERISA reports and filings. 13. Attend meetings with Plan Sponsor (trust or corporate) as necessary for proper administration of the Plan. 14. Provide the Plan Sponsor the plan instruction for reporting its employees' eligibility to the Contract Administrator. AX 7/85 ....