Common use of Claims Administration Clause in Contracts

Claims Administration. MHHSI will administer claims in accordance with the terms of the Plan, including the Plan Document. Specific provisions pertaining to Plan Sponsor’s claims liability are set forth in Exhibit D to this Agreement. Claims administration services shall include the following: a. Receive and review claims and claim documents; b. Verify eligibility and medical necessity and determine amounts payable under the Plan in conjunction with the Plan Document provisions concerning reasonableness of charges and preferred provider or other service arrangements; c. Correspond with claimants to obtain any required additional information and to determine whether other coverage for a claim may exist under subrogation rights or other benefit plans, insurance contracts, or government-sponsored benefit programs; d. Prepare and mail or provide via electronic communication explanations of benefits or denial of benefits;