current, complete and confidential records
and files of claims for each covered person
for determination of plan benefits and satisfaction
|Adjudicate all claims in
accordance with the benefit levels and provisions
of the self-funded plan document, including
determination and administration of reasonable
and customary charges, the coordination of
benefits with other group plans, appropriate
claim control practices, and request forms
for obtaining additional information.
and distribute benefit checks and explanation
of benefits to employees, employers, and/or
|Verify and handle inquiries
from the employer, employees, hospitals, doctors,
and other service providers concerning requirements,
procedures, or benefits of the plan. Verification
of benefits is done in writing via facsimile
or electronic signature. Written verification
protects our clients as well as Nexcaliber.
audits of high risk/high potential claims.
|Provide periodic claim
summaries and reports.
and submit all premium reports, statements,
claim reports, and other reports required
to all insurers and reinsurers of the plan.
|Provide information necessary
for reporting of ERISA IRS 5500 forms.
assistance in evaluating and implementing
benefit additions or modifications.
|Provide assistance in obtaining
competitive Excess Risk Insurance (Individual
and Aggregate Stop Loss Coverage) quotes at
claimants with a toll-free 800# telephone
number to inquire about coverage, the status
of a claim, or any other suggestions they
may have. The representative has immediate
access to the database in the on-line system
as well as any hard copy files that were submitted.
Providers may also discuss the extent of coverage
for anticipated services.