Specifications include, but are not limited to: To provide and administer dental services through a PPO, including but not limited to, an out-of-network option to all eligible enrollees enrolled through the Board ("Covered Persons"). Covered Persons will be Board employees and their dependents whose names are provided to the Proposer by Board as being eligible to receive dental and related services. Board may add or delete Covered Persons on a monthly basis. a. The Proposer shall exercise reasonable judgment in determining whether a claim submitted by Covered Persons under the Group Dental Plan is eligible for payment, after so determining,paying any and all claims filed pursuant to the terms, conditions and benefits thereunder. b. The Proposer shall furnish the Board weekly accountings showing the amount of claims paid during the preceding week. The accountings will be in a format to be mutually agreed upon. Within forty-eight (48) hours of the date of receipt of the accounting, Board shall pay the Proposer via electronic transfer of funds the amount shown on the prior week accounting as the full amount of claims paid. However in the event of disputed claims, Board shall identify disputed claims and pay the remaining amount shown. The parties shall promptly endeavor to resolve disputes about claims. The Proposer shall in no event be obligated to pay claims except from funds provided by the Board...
