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Service Comments <br /> United reserves the right,from time to time,to change the content,format and/or type of its reports. <br /> E. CLAIMS ADMINISTRATION SERVICES <br /> Service Comments <br /> Claims for Plan benefits must be submitted in a form that is satisfactory to United in order for it to determine whether a benefit <br /> is payable under the Plan's provisions. Customer delegates to United the discretion and authority to use United's claim <br /> procedures and standards for Plan benefit claim determination. <br /> Implementation of Customer's benefians. <br /> Claim history load from one prior carrier using United's <br /> standard process_ <br /> Standard claims processing including: <br /> • Re-pricing and payment of claims. <br /> • Auto and manual adjudication using proprietary software. <br /> • Claim edit/review and cost containment program <br /> _•_ Pending and subsequent claim review. <br /> Standard claim forms when a <br /> Medical claim review of specific health care claims to <br /> promote coding accuracy,benefit interpretation,and apply <br /> reimbursement policy. <br /> Standard coordination of benefits for all claims with <br /> automated investigation once every 12 months. <br /> Production and distribution of monthly Health <br /> _Statements. <br /> Processing of run-out claims(meaning claims incurred prior If the Agreement terminates because Customer fails to pay <br /> to the termination date)for six(6)months following United fees due,fails to provide the funding for the payment of <br /> termination. benefits,or United terminates for any other material breach, <br /> run-out will not apply. <br /> The fee for run-out claims processing is equal to the last two <br /> months'Standard Service Fees in effect at the time of <br /> termination.If Customer terminates this Agreement at the end <br /> of the initial Agreement Period,a matured Standard Service <br /> Fee will be used as the basis for the run-out fee. <br /> United will bill Customer for the full amount of run-out fee <br /> that Customer owes, generally one month prior to the <br /> Agreement's termination date.The full payment of run-out fees <br /> is due and payable before run-out claims processing will begin. <br /> United will only process run-out claims if Customer is current <br /> with all Service Fee obligations at time of termination. <br /> Suspension of Run-out Processing <br /> If Customer does not pay the run-out fees it owes United when <br /> due as set forth above, United will notify Customer. If <br /> Customer does not make the required payment within five(5) <br /> business days of United's notice to Customer,United may stop <br /> issuing checks and non-draft payments and suspend its ran-out <br /> claims processing under this Agreement, such suspension to <br /> apply to all claims regardless of dates of service and shall <br /> remain in effect until such date when Customer makes the <br /> required payment. <br /> Termination of Run-out Processing <br /> Run-out claims processing will terminate:(1)the date United <br /> gives Customer notice of termination because Customer did <br /> not pay the run-out fees Customer owed United when due as <br /> set forth above,or(2)if Customer fails to provide the required <br /> funds for payment of benefits under the terms of this <br /> Agreement.Such termination shall apply to all claims <br /> 18 <br />