Common use of Client Contact Information Clause in Contracts

Client Contact Information. Please provide the Contact Information for those involved in the administration of your plan. NOTE: Only one person may be the Primary contact for each section. Contact #1: Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding (continued) Contact #2: Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Contact #3: Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding