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2011/05/11 Council Agenda Packet
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2011/05/11 Council Agenda Packet
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Council Agenda Packet
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5/11/2011
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9 • <br /> agrees to provide such services, the parties shall describe the mutually agreed <br /> upon services in an Addendum hereto, and include within such Addendum a <br /> mutually agreed upon fee schedule for such services. <br /> 4. Fees to HMA. <br /> (a) Fees for Claims Processing Services. As compensation for the <br /> administration and claims processing services set,forth on Exhibit B, HMA shall <br /> be paid the fees set forth on Exhibit A,which is attached hereto and made a part <br /> hereof. Fees shall be based on the number of Participants enrolled under the <br /> Plan on the first day of the month in which services are being billed, and shall be <br /> due and payable in advance on the first day of the month. Fees for any newly <br /> enrolled Participants' entering on or after the first day of the month shall be <br /> charged retroactive to the date of enrollment and shall be payable on the first <br /> day of the month following the date of enrollment. Any adjustments in fees for <br /> retroactive changes in enrollment will be made on the first billing cycle <br /> immediately following the submission of the change in writing to HMA. <br /> (b) Fees for Other Administrative Services. If the Plan Administrator requests <br /> any other administrative services from HMA hereunder, and HMA agrees to <br /> provide such services, the Plan Sponsor and HMA shall mutually agree in writing <br /> upon a fee schedule for such services and the Plan Sponsor shall pay HMA in <br /> strict compliance with such fee schedule. <br /> (c) Fees from Outside Vendors. HMA shall be entitled to a portion of the fees <br /> charged by outside vendors, as set forth on Exhibit A. <br /> (d) Fees for Negotiated Savings. In the event that HMA is able to negotiate a <br /> reduced fee charged by a provider, HMA shall be entitled to retain a percent of <br /> the negotiated savings as stated in the fee schedule. In the event that additional <br /> saving negotiation services are needed, the Plan Sponsor and HMA shall mutually <br /> agree upon a fee schedule for such services. In the event that HMA is able to <br /> negotiate additional savings with a Preferred Provider,fccs for HMA's negotiation <br /> services will only apply to the additional savings retained. <br /> (e) Fees for Repricing of Out of Network Claims. HMA shall be entitled to <br /> retain 30% (thirty percent) of the gross savings obtained on all out of network <br /> claims that are repriced, reduced by negotiation or reduced due to audit. The <br /> remaining 70% (seventy percent)of savings will be passed on to the client in the <br /> form of reduced claims costs. <br /> There will be no cost to the Plan Sponsor for this service for claims that <br /> experience no repricing or negotiated savings. <br /> (f) Reprocessing Fee. In the event a retroactive amendment or the Plan <br /> Sponsor's failure to fund claims in a timely manner results in the need to <br /> reprocess claims, subject to prior approval, the Plan Sponsor agrees to pay <br /> HMA's expenses in performing that service. <br /> (g) Right to Change Fees. Upon approval of Plan Sponsor, HMA shall have a right <br /> to change any fees charged to the Plan Sponsor hereunder <br /> (i) as of the first day of any Renewal Term; <br /> HMA, Inc.TPA Agreement Page 3 8910-021910 <br /> 14 <br />
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