Laserfiche WebLink
4.06 Services. The"Administrator"agrees to perform the below-enumerated services with II <br /> respect to the processing and payment of claims under the Plan: <br /> a. provide claim forms for submission of claims to the"Administrator"; <br /> b. receive claims and claims documentation; <br /> c. correspond with the Participants and Providers of services if additional information is <br /> deemed by"Administrator"to �necessary to complete the processing of claims; <br /> d. coordinate benefits payable under the Plan with other benefit plans, if any; <br /> e. determine the amount of benefits payable under the Plan; <br /> f. prepare disbursement checks for the amount of benefits determined to be payable <br /> under the Plan; <br /> g. provide notice to Participants as to the reason(s) for denial of benefits and provide far <br /> the review of denied claims; <br /> h use its best efforts in the normal course of its services hereunder to identify cla.ims for <br /> which there is the potential for collection of amounts paid to, or on beha.lf of, <br /> Participants through subrogation of rights of Participants and to notify"EMPLOYER" <br /> of such claims; <br /> i. use its best efforts in the normal course of its services hereunder to identify claims that <br /> may be subject to reimbursement, based upon the existence of any Stop-Loss Policy; <br /> (In no event will the"Administrator"be held liable for any claims not covered by the <br /> Stop-Loss Carrier.) <br /> j. maintain member enrollment for eligibility for payrnent of claims and census data; <br /> k. provide accounting details of all billings and collections; <br /> l. maintain reinsurance reporting; <br /> m. provide enrollment forms and identification cards to "EMPLOYER"for participants. <br /> Identification cards will display the"Administrator's"name and toll-free number. <br /> SECTION V <br /> Preferred Provider Requirements <br /> 5.01 Incentives. "EMPLOYER"meets all required PPO incentives as required by the <br /> Networks, with the current benefit plan as outlined in the Summary Plan Description. <br /> 5.02 Exclusivitv. The Consociate Care PPO Network shall be the exclusive primary network <br /> for the unmediate 60 mile radius surrounding the"EMPLOYER". `BMPLOYER" may <br /> elect to take advantage of a wrap around network, subject to Consocia.tes prior approval. <br /> 5.03 Term, The term of the PPO requirements sha.11 mirror the term of this contract. <br /> 6 <br />