Other Fees or Credits. Fee for Subrogation Services. The charge to Plan Sponsor is 25% of gross subrogation recovery, or, if outside counsel is retained, 15% of the net recovery after a deduction for outside counsel fees. Fee for Provider Audit Performed by External Vendors. The charge to Plan Sponsor is 0% of the amount recovered from Vendor audits of Provider activity, including but not limited to credit balance, hospital xxxx audits, DRG readmissions and high-cost drug audits. Fee for Overpayment Identification Provided by External Vendors. The charge to Plan Sponsor is 0% of the amount recovered from review of Claims and membership data to identify overpayments, including but not limited to COB, duplicates, contract compliance and eligibility. Fee for Collection Services Provided by External Vendors. The charge to Plan Sponsor is 0% of the amount recovered by a Vendor in collecting receivables. Fee for Independent Claims Review: $550.00 per independent review
Other Fees or Credits. Conversion right to an individual insured policy upon termination of coverage. Anthem Blue Cross Life and Health shall have no obligation to provide conversion rights in instances in which this Agreement is terminated for failure to pay any amounts due under this Agreement. The fee shall be:$1,500 per Member conversion
Other Fees or Credits. Not applicable
Other Fees or Credits. Fee for Pharmacy Prior Authorization $55.00 per authorization. Fee for Step Therapy PBM shall charge a fee of $0.30 per pharmacy Claim. Fee for Quantity Limits PBM shall charge a fee of $0.55 per pharmacy Claim for applying frequency and quantity limits to certain Prescription Drugs. Fee for Pharmacy Physician Review $800.00 per review. Fee for Vaccine Administration PBM shall charge a fee for the administration of vaccines at a retail pharmacy location of $2.50 per vaccine. Fee for Medication Review Note PBM shall charge a fee of $0.25 per pharmacy Claim for clinical, quality and cost-of-care messages in personalized Member communications. Fee for Custom Communications PBM shall charge a fee of $1.00 per custom communication requested by the Employer. Fee for Member-Submitted Claims PBM shall charge a fee of $1.00 per Claim for each Member-submitted Claim. Fee for Pharmacy Network Audit Services The charge to Employer is 20.00% of the total amount recovered from periodic onsite or field audits of Network Pharmacies, including but not limited to, audits to determine compliance with billing requirements and the terms and conditions of the Network Pharmacy agreements. These audits are separate and distinct from Claims processing and financial accuracy audits.
