- 410.1P Page 1 of 4 COMPLIANCE AND RISK MANAGEMENT Claims Procedure Where a third party administrator, insurance company, health care services contractor or HMO is in place with respect to a certain benefit, such third party has been delegated the responsibility for administering and determining initial claims and reviewing and reconsidering benefit, enrollment or eligibility denials if appealed (“appeals”).
- The entities that are responsible for administering and determining initial claims and appeals are called “Claims Administrators.” As an example, for participants in the PPO, the Claims Administrator is Healthcare Management Administrators, Inc.
- The Claims Administrator will notif...
410.1P 
