1. ACCOUNT MANAGEMENT Provide a designated Account Manager and Account Management Team 2. CUSTOMER SERVICE Provide a designated call and claim unit with toll free telephone access. Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverage, or other inquiries from participants Monday through Friday from 8:00 AM to 6:00 PM (AZ time) 3. OPEN ENROLLMENT SUPPORT Attend 4 days of Annual Open Enrollment Meetings in Phoenix, Arizona during normal business hours 4. COMMUNICATION/EDUCATION SUPPORT Provide bilingual communication/educational materials 5. BOOKLETS/CERTIFICATES Provide Policy Booklets/Certificates 6. CLAIMS ADMINISTRATION Provide claims forms Receive claims and process payments of benefits in accordance with the plan designs for all claims incurred Correspond with participants if additional information is necessary to complete the processing of claims Determine benefits payable under the Plan, pursuant to the terms and conditions of the District’s Benefit Plans Coordinate benefits payable under the Plan and with other benefit plans, if applicable Provide notice to the Participants regarding the reason(s) for denial of benefits (which are denied) and provide for the review of such denied claims Provide W2 and 1099 forms, if needed Administer a Fraud and Abuse Detection Program
