R99-108 AUTHORIZING APPLICATIONS

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� EXHIBIT 11 ADMINISTRATIVE SERVICES INCLUDED IN THE COMPENSATION TO CLAIM ADMINISTRATOR • CLAIMS ADJUDICATION Examination of claims and determination of payment levels, including data entry of claims by claims departments,maintenance of claims experience files, use of inedical consultants,review of utilization and reasonable and customary charges and Coordination of Benefits (COB). • CLAIMS/MEMBERSHIP INQUIRIES Handling of inquiries--written, phone or in-person-related to membership, benefits,and Claim Pay- ment, Net Claim Payment or denial. • ENROLLMENT SERVICE Preparation of proposals and registration, coding, and preparation of new application. • MEMBERSHIP VALIDATION Verification of inembership by wire, listing, CRT query or other method prior to or during adjudication. • MEMBERSHIP FILE UPDATES Maintenance of inembership status files, processing of inter-plan transfers, and processing of con- tract conversions and changes, subject to conversion fee. • • OTHER SERVICES TO GROUPS Contacts the Employer or Covered Employees regarding adding, changing or renewing coverage. • STANDARD REPORTS (not including PROBE - "Pertormance Report of Blue Cross Experience") Generation of monthly statements and claim listings. • ACTUARIAL AND STATISTICAL Determination of claims projections and pricing of administrative services and stop-loss coverage. • FINANCIAL SERVICES Financial functions such as cash receipts, cash disbursements, payroll and general ledger proces- sing,general accounting,preparation of financial statements, billing,group settlement and wire trans- fers. • PPO Establish, arrange and maintain preferred provider organization physician and hospital provider net- work through contractual arrangements with Preferred Participating Hospitals and/or Preferred Parti- cipating Physicians within the designated service area. • CERTIFICATE OF CREDITABLE COVERAGE At the written direction of the Employer, issuance of a Certificate of Creditable Coverage. � - 19 -