East Coast Underwriters Medical Solutions Program
Compliance with ECU’s Medical Solutions Program is mandatory for both Traditional, EZ Funding and EZ AGG™ Groups preferred pricing.
ECU requires that we be notified via Email prior to payment on large claims as follows:
- $10,000 on EZ AGG™ Groups
- 50% of the Specific deductible on traditional groups.
The following information must be provided prior to payment of the claim:
- The In Network discount amount*
- The Out of Network discount amount*
- A copy of the UB-92
*ECU reserves the right to try to obtain a better discount if the discount presented is less than what is considered Reasonable.
When a claimant reaches 50% of the Specific Deductible ($10,000 for EZ AGG groups) or has a Trigger Dx, we require (See ECU’s Claim notices & Filing Procedures for the trigger Dx list):
- Weekly Precert reports
- Monthly Large Case Management reports
ECU Preferred Vendors
Please note preferred vendors of the TPA may be substituted for ECU’s preferred vendors with approval from ECU. (ECU will also provide plan language for the proposed SPD amendments, when requested.)