Ala. Admin. Code r. 482-1-115-.07
Current through Register Vol. 43, No. 1, October 31, 2024
Section 482-1-115-.07 - Claims Administrator(1) The Board shall select a Claims Administrator or Administrators through a competitive bidding process to process claims of members of the benefit plan or plans and other administrative duties as determined by the Board. The Board shall evaluate bids submitted based on criteria established by the Board which shall include all of the following:(a) The Claims Administrator's proven ability to handle health insurance coverage for individuals.(b) The efficiency and timeliness of the Claims Administrator's claim processing procedures.(c) An estimate of total charges for the services to be provided.(d) The Claims Administrator's ability to apply effective cost containment programs and procedures and to administer the claims of the benefit plan or plans in a cost efficient manner.(e) The financial condition and stability of the Claims Administrator.(2) The Claims Administrator or Administrators shall serve for a period specified in the contract between the Claims Administrator or Administrators and the Board, subject to removal for cause and subject to any terms, conditions and limitations of the contract.(3) The Claims Administrator or Administrators shall perform such functions relating to the benefits plan or plans as may be assigned, including, but not limited to, the following: (a) Provider network negotiations.(4) The Claims Administrator or Administrators shall submit regular reports to the Board regarding the functions performed pursuant to the contract. The frequency, content and form of the report shall be specified in the contract between the Board and the Claims Administrator or Administrators. Author: Elizabeth Bookwalter, Associate Counsel
Ala. Admin. Code r. 482-1-115-.07
New Rule: July 23, 1997; effective August 30, 1997. Revised: November 13, 2002; effective December 29, 2002. Filed with LRS December 19, 2002. Rule is not subject to the Alabama Administrative Procedure Act.Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-52-1, etseq.