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<br />1. Report detailing checks paid by including payee, provider, and amount by <br />fax. <br /> <br />2. Copy of a summary of explanation of benefits (EOB) shall be provided. <br /> <br />(b) Monthly: <br /> <br />1. Experience reports of paid and incurred claims by benefit (medical, dental, <br />prescription) for employee and dependents. <br /> <br />2. A claims problem or pending report showing reason for delay; e.g., <br />coordination of benefits, reasonable & customary, lack of information, or <br />other such items. <br /> <br />3. Analysis by type of service. <br /> <br />4. Monthly aggregate year-to-date reports for all claims. <br /> <br />5. Large claims & claims exceeding specific stop-loss. <br /> <br />6. Turnaround report. <br /> <br />7. Updated listing of changes in PPO providers (furnished monthly at a <br />minimum by the 20th of each month for inclusion in employee newsletter). <br /> <br />8. Census by benefit type. <br /> <br />9. Specific claims - (all cumulative claims exceeding 50% oflSL). <br /> <br />10. Pharmacy: Generic vs. Name Brand; Top prescribing doctors; top 10 <br />dispensed drugs and costs; retail vs. mail order dispensing trends and <br />dollars; total dollars less copays (net costs); eligibility vs.utilization; per <br />member per month costs; per employee per month costs; cost per script <br />(generic, name, mail order and overall). <br /> <br />11. Pharmacy: generic vs. name brand dispensing; top prescribing doctors <br />(number of scripts, units dispensed, total dollars); top 10 dispensed drugs <br />and dollars; retail vs. mail order dispensing trends, total dollars less <br />copays (net cost); eligibility vs. utilization; per member per month costs; <br />savings reports, cost per Rx, cost per employee per month. <br /> <br />(c) Quarterly; <br /> <br />1. Summation of monthly reports and claims experience. <br /> <br />5 <br />