Claims Administration

Marlton Risk Group works in partnership with our producers to coordinate efforts at controlling excess loss claim costs. We believe that developing this partnership, with emphasis on mutual respect for each other's operations and responsibilities, assists our producers in providing their clients with exemplary service.

TPA's are required to submit large claim notifications as soon as a claim is paid, pended, held or suspended at 50% of the medical stop-loss deductible. As these are submitted, Marlton Risk Group will review them for potential reimbursement.

For incomplete claim submissions and those requiring additional information, a preliminary audit letter is sent to the TPA. This correspondence outlines the information necessary to fully process the reimbursement.

Marlton Risk Group pays all approved claims daily. In addition to processing claim checks, we have the ability to wire transfer claim payments.

All TPA's should provide a complete aggregate report by group on a monthly basis. If an aggregate claim needs to be filed, the TPA submits a request for reimbursement, a loss ratio report, and all other requested documentation. The reports are reviewed along with the year-end census to determine that proper premium amounts have been paid. Aggregate claims may require an on-site audit before final adjudication.

All data reviewed by Marlton Risk Group is maintained on an individual claimant basis and is confidential.

If you have any questions, please don't hesitate to contact: