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• EXHIBIT 1 <br /> ADMINISTRATIVE SERVICES <br /> INCLUDED IN THE COMPENSATION TO CLAIM ADMINISTRATOR <br /> • CLAIMS ADJUDICATION <br /> Examination of claims and determination of payment levels, including data entry of claims by claims <br /> departments, maintenance of claims experience files, use of inedical consultants, review of utilization <br /> and reasonable and customary charges and Coordination of Benefits (COB). <br /> • CLAIMS/MEMBERSHIP INQUIRIES <br /> Handling of inquiries --written, phone or in-person - related to membership, benefits, and Claim Pay- <br /> ment, Net Claim Payment or denial. <br /> • ENROLLMENT SERVICE <br /> Preparation of proposals and registration, coding, and preparation of new application. <br /> • MEMBERSHIP VALIDATION <br /> Verification of inembership by wire, listing, CRT query or other method prior to or during adjudication. <br /> • MEMBERSHIP FILE UPDATES <br /> • Maintenance of inembership status files, processing of inter-plan transfers, and processing of con- <br /> tract conversions and changes, subject to conversion fee. <br /> • OTHER SERVICES TO GROUPS <br /> Contacts the Employer or Covered Employees regarding adding, changing or renewing coverage. <br /> • STANDARD REPORTS <br /> (not including PROBE— "Performance Report of Blue Cross Experience") <br /> Generation of monthly statements and claim listings. <br /> • ACTUARIAL AND STATISTICAL <br /> Determination of claims projections and pricing of administrative services and stop-loss coverage. <br /> • FINANCIAL SERVICES <br /> Financial functions such as cash receipts, cash disbursements, payroll and general ledger proces- <br /> sing, general accounting, preparation of financial statements, billing, group settlement and wire trans- <br /> fers. <br /> • <br /> - 15 - <br />