Inter-Plan Arrangements. Certain fees and compensation are charged each time a Claim is processed through the BlueCard Program and include, but are not limited to, Access Fees, Administrative Expense Allowance Fees, Central Financial Agency Fees and ITS Transaction Fees. Other Inter-Plan Arrangement related fees that Anthem may charge include, but are not limited to, fees for BlueCross Blue Shield Global Core® Program services. These fees may be separately billed or included in Paid Claims. The extent to which these fees and compensation are (i) included in the Base Administrative Services Fee; or (ii) included in Paid Claims or separately billed to Employer is as follows: BlueCard Fees Access Fees and AEA will be included in the Base Administrative Services Fees for Claims incurred in the Anthem Service Areas for the following states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Access Fees (Network Provider Claims only): • 3.79% for fewer than 1,000 PPO traditional enrolled Blue Subscribers of network savings, capped at $2,000.00 per Claim. Administrative Expense Allowance Fees ("AEA") (Network Provider and Non-Network Provider Claims): • An amount not to exceed $5.00 per professional Claim and $11.00 per institutional Claim. • Non-Network Provider - $3.00 per Claim. Central Financial Agency Fee ("CFA") (Network Provider, Non-Network Provider and Blue Cross Blue Shield Global Core Claims): • $0.35 per payment notice. ITS Transaction Fee ("ITS") (Network Provider, Non-Network Provider and Blue Cross Blue Shield Global Core Program Claims): • $0.05 per transaction. Negotiated Arrangement Fees - Not Applicable Blue Cross Blue Shield Global Core Fees Administrative Expense Allowance Fee: • $4.35 per Member-submitted Claim; • $5.50 per professional Claim; and • $18.55 per institutional Claim. All other fees associated with the Blue Cross Blue Shield Global Core program, except the CFA and ITS Fees described above, are included in the Base Administrative Services Fee.
Inter-Plan Arrangements. 1. Out-of-Area Services The Plan has a variety of relationships with other Blue Cross and/or Blue Shield Licensees, referred to generally as “Inter-Plan Arrangements”. These Inter-Plan Arrangements operate under rules and procedures issued by the Blue Cross Blue Shield Association (“Association”). Whenever Members access health care services outside the geographic area the Plan serves, the claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described generally below. Typically, when accessing care outside the geographic area the Plan serves, Members obtain care from health care providers that have a contractual agreement (“participating providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, Members may obtain care from health care providers in the Host Blue geographic area that do not have a contractual agreement (“non-participating providers”) with the Host Blue. The Plan remains responsible for fulfilling its contractual obligations to the Member. The Plan payment practices in both instances are described below.
Inter-Plan Arrangements. Federal/State Taxes/Surcharges/Fees In some instances federal or state laws or regulations may impose a surcharge, tax or other fee that applies to self-funded accounts. If applicable, Claim Administrator will charge any such surcharge, tax or other fee to Employer, which will be Employer’s liability.
Inter-Plan Arrangements. Certain fees and compensation are charged each time a Claim is processed through the BlueCard Program and include, but are not limited to, Access Fees, Administrative Expense Allowance Fees, Central Financial Agency Fees and ITS Transaction Fees. Other Inter-Plan Program related fees that Anthem may charge include, but are not limited to, fees for BlueCross Blue Shield Global Core® Program services. These fees may be separately billed or included in Paid Claims. The extent to which these fees and compensation are (i) included in the Base Administrative Services Fee; or (ii) included in Paid Claims or separately billed to Client is as follows: Negotiated Arrangement Fees - Not Applicable
Inter-Plan Arrangements. This Article is intentionally omitted and replaced by the Inter-Plan Arrangements Schedule.
Inter-Plan Arrangements. 1. Out-of-Area Services
Inter-Plan Arrangements. Certain fees and compensation are charged each time a Claim is processed through the BlueCard Program and include, but are not limited to, Access Fees, Administrative Expense Allowance Fees, Central Financial Agency Fees and ITS Transaction Fees. Other Inter-Plan Program related fees that Anthem may charge include, but are not limited to, fees for BlueCross Blue Shield Global Core® Program services. These fees may be separately billed or included in Paid Claims. The extent to which these fees and compensation are (i) included in the Base Administrative Services Fee; or (ii) included in Paid Claims or separately billed to JPA is as follows: BlueCard Fees AEA will be included in the Base Administrative Services Fees for Claims incurred in the following states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Access Fees (Network Provider Claims only): • 2.11% for 1,000–9,999 Blue PPO enrolled Subscribers of network savings, capped at $2,000.00 per Claim. Central Financial Agency Fee ("CFA") (Network Provider, Non-Network Provider and Blue Cross Blue Shield Global Core Claims): • $0.35 per payment notice. ITS Transaction Fee ("ITS") (Network Provider, Non-Network Provider and Blue Cross Blue Shield Global Core Program Claims): • $0.05 per transaction. Blue Cross Blue Shield Global Core Fees Administrative Expense Allowance Fee: • $3.75 per Member-submitted Claim; • $4.75 per professional Claim; and • $17.00 per institutional Claim. All other fees associated with the Blue Cross Blue Shield Global Core program, except the CFA and ITS Fees described above, are included in the Base Administrative Services Fee.
