Laserfiche WebLink
DocuSign Envelope ID: 5332467E-CBEF-4C5D-8BOE-61 E380BDAl 1 B <br />DocuSign Envelope ID: 151ECOCF-B55C414F-9455-72004347A310 <br />(1/2023 Version) <br />Mana ement(AUM Bundle) <br />7dvancedzation <br />River County Board of County <br />$0.46 / PMPM or Passed through from PBM <br />issioners Clinical -All Plans -Remove MCAP <br />nSP fee <br />Member -submitted paper claims processing fee <br />$3.00 per claim <br />Commercial, Medicaid or Medicare subrogation claims fee <br />$3.00 per claim <br />Advanced Opioid Management Program <br />$0.32 / PMPM (If Elected <br />ACA Statin "Trend Management" Program <br />Combined Benefit Management <br />$0.03 / PMPM If Elected <br />Services to manage combined medical -pharmacy benefits <br />$0.10 PMPM per combined accumulator up to <br />that are not a consumer -directed health (CDH) plan. <br />maximum of $0.20 PMPM for existing <br />Services include ongoing management of the data exchange <br />connection with medical carrier or TPA. <br />platform with the medical vendor/TPA, production <br />monitoring and quality control. and designated operations <br />Fees to establish connection with new medical <br />team. Combined benefit types may include deductible, out <br />carrier or TPA are quoted upon request. <br />of pocket, spending account, and lifetime maximum. <br />(OptionsN'et%%ork Pharmacy Service Audits :. <br />by of <br />submitted per Client) <br />Audit Option One: Enhanced Plus Network Pharmacy <br />$0.04 Per Claim <br />Audit. Next day paid claim review with lower dollar (i.e., <br />Program Max Annual Billing $300,000.00 <br />S50 claim) thresholds. Standard 4% field audit of network <br />with >250 ESI claims. Client -specific field audit of <br />network, special reporting, unique audit modules, specific <br />Client claim audits, regional auditing, extensive compliance <br />checks. Includes next day desk paid claim auditing and <br />standard audit summary reports. 100% of recoveries <br />returned to Client. <br />Audit Option Two: Basic Network Pharmacy Audit: <br />No Charge <br />30-60 day historical review of paid claims (no next day <br />review) and high thresholds, so lower dollar claims not <br />reviewed. 100% of recoveries returned to Client. Very <br />limited ability for Client requested audits if mutually <br />agreed. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED IIEREIN IS CONFIDENTIAL, PROPRIETARl <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />