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<br />TLC Administrators Self-Funded Quote <br />TIlE <br />LIPMAN <br />COMPANY, INe. <br /> CLAIMS ADMINISTRATION DUTIES: <br /> As administrator, TLC Administrators shall... <br /> .. Be responsible for the payment of all claims received for active and retired members <br /> in accordance with the benefits adopted by the plan and with the rules of ERISA. <br /> Special attention will be directed to the subject's eligibility, coordination of benefits, <br /> excessive utilization, pre-authorization and third party liability. <br /> · Develop ongoing auditing procedures with special emphasis on large and denied <br /> claims. This audit will implement two methods: 1) automatic review of large claims <br /> and denied claims that are routine and 2) formal internal auditing procedures. <br /> These audits will be performed on a quarterly basis during the first year of our <br /> administration and semi-annually thereafter. <br /> · Provide all data processing services (tabulations, registers, reports, controls, check <br /> vouchers and accompanying EOB's) needed to provide the claims payment services <br /> described herein. <br /> · Provide records of payments made to providers, claim statistics for each of the <br /> plan's benefits (as required by the consultant) and confirm eligibility and benefits <br /> available to hospitals making telephone inquiries. <br /> · Consult with and cooperate with the consultant, plan manager, appointed actuary <br /> and counsel to the board regarding all communicative functions. <br /> · Distribute all forms utilized in the payment of claims of the plan to all employers and <br /> employees participating in the plan, as required and without limitation. <br /> · Retain dental consultants to review questionable claims at the cost of the client. <br /> · Be responsible for the maintenance of all files and records of the plan, including <br /> original claim forms, other basic documents and correspondence. All documents <br /> referred to in this proposal are the property of the client and shall be open all <br /> reasonable times for inspection and copying by the board or its duly authorized <br /> agents. <br /> · Provide any and all information with respect to the plan which may reasonably be <br /> requested by the client, consultant, counselor plan manager. <br /> 4 <br /> r· <br />