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2023-098B
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Last modified
3/18/2024 12:03:39 PM
Creation date
3/18/2024 11:53:00 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/16/2023
Control Number
2023-098B
Agenda Item Number
12.D.2.
Entity Name
Blue Cross and Blue Shield
Subject
Shield Transition Health Plan Administrative Services from
Blue Cross Shield of Florida Inc.(Florida Blue)
to Blue Cross Blue Shield National Alliance effective 10/01/2023 thru 9/30/2026
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Value -Based Programs incentives/Shared Savings settlements to accounts are <br />outside of the claim system. BCBSF and/or its Designated Agent will pass these <br />Host Blue charges directly through to Employer as a separately identified amount <br />on the group billings; or, <br />Where Host Blues pass on the costs of Value -Based Programs to BCBSF and/or its <br />Designated Agent as PMPM amounts not attached to specific claims, BCBSF <br />and/or its Designated Agent may elect to pass these amounts to Employer as a claim <br />amount. <br />The amounts used to calculate either the supplemental factors for estimated pricing or <br />PMPM billings are fixed amounts that are estimated to be necessary to finance the cost <br />of a particular Value -Based Program. Because amounts are estimates, there may be <br />positive or negative differences based on actual experience, and such differences will be <br />accounted for in a variance account maintained by the Host Blue (in the same manner as <br />described in the BlueCard claim pricing section above) until the end of the applicable <br />Value -Based Program payment and/or reconciliation measurement period. The amounts <br />needed to fund a Value -Based Program may be changed before the end of the <br />measurement period if it is determined that amounts being collected are projected to <br />exceed the amount necessary to fund the program or if they are projected to be <br />insufficient to fund the program. <br />At the end of the Value -Based Program payment and/or reconciliation measurement <br />period for these arrangements, Host Blues will take one of the following actions: <br />Use any surplus in funds in the variance account to fund Value -Based Program <br />payments or reconciliation amounts in the next measurement period. <br />• Address any deficit in funds in the variance account through an adjustment to <br />the PMPM billing amount or the reconciliation billing amount for the next <br />measurement period. <br />The Host Blue will not receive compensation resulting from how estimated, average or <br />PMPM price methods, described above, are calculated. If Employer terminates, you will <br />not receive a refund or charge from the variance account. This is because any resulting <br />surpluses or deficits would be eventually exhausted through prospective adjustment to the <br />settlement billings in the case of Value -Based Programs. The measurement period for <br />determining these surpluses or deficits may differ from the term of this Agreement. <br />Variance account balances are small amounts relative to the overall paid claims amounts <br />and will be liquidated over time. The timeframe for their liquidation depends on variables, <br />including, but not limited to, overall volume/number of claims processed and variance <br />account balance. Variance account balances may earn interest, and interest is earned at <br />the federal funds or similar rate. Host Blues may retain interest earned on funds held in <br />variance accounts. <br />Note: Members will not bear any portion of the cost of Value -Based Programs except <br />when a Host Blue uses either average pricing or actual pricing to pay providers under <br />Value -Based Programs. <br />Care Coordinator Fees <br />33 <br />
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