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<br />J. We agree to process any written requests, issues or comments received from Eligible <br />Persons on appeals of denied benefits and forward the information to the Employer for <br />review and decision. <br />k. We agree upon receipt of the Employer's written decision of benefit appeals, to calculate <br />any amount due and payable and make payment, or issue a denial notice, all in accordance <br />with written instructions ofthe Employer. <br />I. We agree to notify 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 services 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 refund 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 Attachment 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. You will be the custodian of this account and will be responsible for <br />depositing all funds necessary to pay said claims. This account must utilize the 'positive <br />pay' feature of the banking process. Through this process, TML IEBP will be responsible <br />for transmitting a daily file, which gives an electronic listing of all checks written the night <br />before. TML IEBP will be a signer on the account for check writing purposes only. We <br />will use the facsimile signature of the Chairman of our Board of Trustees to sign your <br />checks. You agree to have your own personnel listed as authorized signers, for the purpose <br />of inquiries, research or reconciliation of the account. <br /> <br />Any fees associated with the establishment 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 the 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 information and assistance we may need to <br />properly administer the Plan. <br /> <br />DRAFT 6-6-01 <br /> <br />Page 3 of 5 <br />