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EXHIBIT 10.88
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FOURTH 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 as of this 1st day of January, 1993, between
HealthCare COMPARE Corp. (hereinafter called "COMPARE"), and National
Association of Letter Carriers Health Benefit Plan (hereinafter called
"CARRIER").
WITNESSETH
WHEREAS, COMPARE AND CARRIER have heretofore entered into a certain UTILIZATION
REVIEW AGREEMENT, dated January 1, 1989, and amended on November 1, 1989,
January 1, 1991, and December 31, 1991, 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, 1993, the revised Schedule of Fees, attached
hereto and made a part hereof, and shall replace and supersede all
previous Schedule of Fees.
B. Parties hereby ratify and affirm the Utilization Review Agreement
and agree that it is in full force and 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.
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. Xxxxxxxxx By: Xxxxx X. Xxxxx
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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, 1993 - December 31, 1993*
MEDICAL/SURGICAL HOSPITAL REVIEW ................. $1.43 per enrollee per month
CASE MANAGEMENT .................................. $200 per hour**
MENTAL HEALTH SERVICES REVIEW ................... $0.25 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
