Delegation Responsibilities & Penalties. The capitation amounts paid to Group by Blue Shield as set forth in Paragraph 7.1 (a) of this Agreement are based on Blue Shield’s expectation that the Group accepts and will perform delegation of the requirements set forth as Group’s responsibility in Attachments I, II, III and IV of this Exhibit F. The quality improvement and quality management obligations of Blue Shield are not delegated to Group; however, Group shall have its own fully functional Quality Management Program, as described in Attachment I, that is cooperative with and integrated into the Blue Shield Quality Management Program. In accordance with paragraph 4.3 (c) of this Agreement, the net monthly capitation penalty reduction for any de-delegated function shall be as follows: Commercial Blue Shield 65+ UM / Professional 2.0 % NA UM / Shared Savings 2.0 % NA Credentialing 0.5 % NA Claims Processing Non-contracted Only Penalty 0.7 % NA All Claims Penalty 5.0 % NA Non-contracted Only Payment Withhold * 8.5 % NA All Claims Payment Withhold 85.0 % NA * = Subject to actual claims paid experience. All other conditions and terms of this Agreement shall remain the same. When executed by both parties, this Amendment shall be effective as of July 1, 2003. BLUE SHIELD OF CALIFORNIA PROSPECT HEALTH SOURCE MEDICAL GROUP By: /s/ XXXX XXXXXX By: /s/ XXXXX XXXX XXXX XXXXXX XXXXX XXXX SENIOR VICE PRESIDENT, Title: VICE PRESIDENT, PROVIDER RELATIONS Title: BUSINESS DEVELOPMENT
Delegation Responsibilities & Penalties. The capitation amounts paid to Group by Blue Shield as set forth in Paragraph 7.1 (a) of this Agreement are based on Blue Shield’s expectation that the Group accepts and will perform delegation of the requirements set forth as Group’s responsibility in Attachments I, II, III and IV of this Exhibit F. The quality improvement and quality management obligations of Blue Shield are not delegated to Group; however, Group shall have its own fully functional Quality Management Program, as described in Attachment 1, that is cooperative with and integrated into the Blue Shield Quality Management Program. In accordance with paragraph 4.3 (c) of this Agreement, the net monthly capitation penalty reduction for any de-delegated function shall be as follows: Commercial Blue Shield 65 Plus UM/Professional 3.0 % 3.0 % UM/Shared Savings 3.0 % 3.0 % Credentialing .5 % .5 % Claims Processing Non contracted only penalty .7 % .7 % All Claims penalty 7.0 % 7.0 % Non contracted only payment withhold* 8.5 % 8.5 % All Claims payment withhold* 85.0 % 85.0 % *Subject to actual claims paid experience. Dedelegation penalties for Claims Processing do not apply in cases where Blue Shield participates in joint administration of claims processing on Group’s premises, however, Group shall reimburse Blue Shield for Blue Shield’s cost of providing on site assistance and shall provide workstations and equipment as required.
