Laserfiche WebLink
<br />3 <br /> <br />Sample Letter to TPA <br /> <br />July 1, 1999 <br /> <br />RE: City of San Marcos <br />Policy Effective Date August 1, 1999 <br />Specific Deductible: $40,000 <br />Name of Stop Loss Carrier: American National Insurance Company <br /> <br />Dear <br /> <br />As you know, our company's medical stop loss coverage for the period beginning August 1, 1999 has <br />been purchased from American National Insurance Company through .-\merican Stop Loss Insurance <br />Brokerage Services, Inc (ASL). In order for us to receive reimbursement for any excess loss claims that <br />may be incurred, the reinsurance carrier requires claim notification in a timely manner A critical <br />component of that process is that Specific and Aggregate Claims data be provided to the carrier. via <br />American Stop Loss, on a monthly basis. Your reports to the carrier, via .-\merican Stop Loss, should <br />include: <br /> <br />Written notice of any and all cases where an individual's claims exceed, or are expected to <br />exceed, 50% of the deductible. This information should be filed with the carrier, via American <br />Stop Loss, every month and should include monthly and year-ta-date claim totals with diagnosis <br />and prognosis, if available. Other pertinent medical data. such as Large Case Management <br />(LCM) notes or Attending Physician Statements (APS') should also be included; <br /> <br />If aggregate coverage has also been purchased, monthly reports showing the number of <br />enrollees and paid claims for that month and year-ta-date totals should also be included; <br /> <br />Therefore, please let this letter serve as a formal written directive and authorization for you to report <br />monthly claims to the carrier via American Stop Loss. Please send the data to the following address: <br /> <br />Mr. Patrick Moore, Claims/Compliance Manager <br />American Stop Loss Insurance Brokerage Services, Inc. <br />250 Commercial Street Suite 200 <br />Worcester, MA 01608 <br /> <br />Should you have any questions, please feel free to contact me. <br /> <br />Sincerely, <br /> <br /><Name of Authorized Representative> <br /> <br />cc: Patrick Moore, American Stop Loss <br />