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k. We agree upon receipt of the Employer's written decision of benefit appeals, to calculate <br /> any amount due and payable, or issue a denial notice, all in accordance with written <br /> iustruetions of the Employer. <br /> I. We agree to notit~ stop loss carriers of potential claims and provide all reporting required <br /> by stop loss carriers. <br /> m. We agree to provide coordination of benefit serviaes and pursue subrogation on behalf of <br /> the employer, when applicable. Subrogation is handled by in house counsel and a third <br /> party vendor who retains a percent of the recovery. <br /> n. We agree to rethnd all amounts paid over the specific stop loss limit within ten (10) days <br /> of approval by the stop loss carrier. <br /> o. We agree to refund all amounts paid over the aggregate stop loss attachment point within <br /> ten (10) days of approval by the stop loss carrier. <br /> p. We agree to provide pre-certification, continued stay review, discharge planning and large <br /> case management as needed. <br /> q. We agree to use the HealthChex auto-audit to review your claims at no additional cost, as <br /> directed by you on Addendum B to this Agreement. <br /> r. We agree to receive claims electronically for your eligible persons to the extent providers <br /> are capable of electronic submission. <br /> s. We agree to maintain claims processing data on microfilm or optical disk for three (3) <br /> years and provide you with copies of this data for individual requests within two (2) <br /> business days following receipt. <br /> t. We agree to provide your bank with a daily 'positive pay' file, which documents which <br /> claims were paid each business day. <br /> <br />II. YOUR DUTIES <br /> <br /> a. You agree to establish a checking account at your bank, which will be used to pay all of <br /> your claims per Addendum A. You will be the custodian of this account and will be <br /> responsible tbr depositing all funds necessary to pay said claims. This account must utilize <br /> thc 'positive pay' feature of the banking process. Through this process, TML IEBP will be <br /> responsible for transmitting a daily file, which gives an electronic listing of all checks <br /> written the night before. TML IEBP xvill be a signer on the account for check writing <br /> purposes only. We will use the facsimile signature of the Chairman of our Board of <br /> Trustees to sign your checks. You agree to have your own personnel listed as authorized <br /> signers, l~br the purpose of inquiries, research or reconciliation of the account. <br /> <br /> Any fees associated with the establishmcot or daily process and operation of this account <br /> will be your responsibility. <br /> <br /> If this account is not maintained and properly funded, we may at our option, take any of the <br /> following actions: <br /> (i) suspend thc processing and payment of your claims; <br /> (ii) terminate this Agreement immediately by written notice to you. <br /> b. You agree to provide us in a timely fashion all infomaation and assistance we may need to <br /> properly administer the Plan. <br /> <br /> c. You agree to verit~ according to your plan document, the eligibility of any persons who <br /> request coverage tinder your plan. Your verification of eligibility will be indicated on the <br /> enrollment record in the space provided for "Employer Acceptance". Once accepted by <br /> <br /> I)agc 3 of 5 <br /> <br /> <br />