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EXHIBIT 10.89
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FIFTH AMENDMENT TO THE UTILIZATION REVIEW AGREEMENT
DATED
JANUARY 1, 1989, AS AMENDED,
BETWEEN
HEALTHCARE COMPARE CORP.
AND
NATIONAL ASSOCIATION OF LETTER CARRIERS
HEALTH BENEFIT PLAN
THIS AGREEMENT is entered into as of this first day of January, 1994, between
HealthCare COMPARE Corp. (hereinafter called "COMPARE"), and National
Association of Letter Carriers Health Benefit Plan (hereinafter called
"CARRIER").
WITNESSETH
WHEREAS, COMPARE AND COMPANY have heretofore entered into a certain UTILIZATION
REVIEW AGREEMENT, dated January 1, 1989, and amended on November 1, 1989,
December 31, 1991, January 1, 1991 and January 1, 1993, which provides for
utilization review services to be rendered to CARRIER,
WHEREAS, COMPARE and CARRIER desire to amend the Utilization Review Agreement
in the manner set out herein.
NOW, THEREFORE, in consideration of the mutual covenants and agreements set
out herein, one dollar and other good and valuable consideration, receipt of
which is hereby acknowledged, the parties hereto agree as follows:
A. Effective January 1, 1994, the revised Schedule of Fees, attached
hereto and made a part hereof, shall replace and supersede all
previous Schedule of Fees.
B. Parties hereby ratify and affirm the Utilization Review Agreement as
amended, and agree that it is in full force effect and valid except
as amended herein. This Amendment shall prevail over any
conflict with the Utilization Review Agreement. In all respects the
Utilization Review Agreement shall be construed and interpreted to
include all of the terms of this Amendment as if the same were set out
therein. The execution and delivery of this Amendment by the
undersigned has been duly authorized by all necessary corporate action.
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IN WITNESS WHEREOF the duly authorized representatives of the parties have
executed this Amendment as of the day and year first above written.
National Association Of Letter Carriers HealthCare COMPARE Corp.
Health Benefit Plan
By: Xxxxxxx X. Sombrotlo By: Xxxxx X. Xxxxx
---------------------------- ---------------------------
President
Title: President
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Date: 1/3/94 Date:
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NATIONAL ASSOCIATION OF LETTER CARRIERS
HEALTH BENEFIT PLAN
Schedule of Fees
Effective January 1, 1994 - December 31, 1994*
MEDICAL/SURGICAL HOSPITAL REVIEW (Est) $1.47 per enrollee per month
.................
CASE MANAGEMENT .................................. $200 per hour**
MENTAL HEALTH SERVICES REVIEW (Est) $0.26 per enrollee per month
Plus $200 per hour*** ...................
ADDITIONAL SERVICES:
Medical Record Photocopies ....................... FEE WAIVED****
ADMINISTRATIVE RUN-OFF FEE ....................... 50% of the final monthly fee
* Adjustments to fees will be made annually.
** The hourly charge is for time and services of staff personnel who may
be physicians, registered nurses, or allied personnel.
*** The hourly charge is the all activity associated with
practitioner-to-practitioner review and independent chart review.
**** COMPARE will photocopy 180 medical records per year at no charge to
NALC. Each record in excess of 180 will be billed at $100 per hour for
staffing and equipment costs.
November 30, 1993
