My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2025-125
CBCC
>
Official Documents
>
2020's
>
2025
>
2025-125
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/23/2025 10:25:09 AM
Creation date
6/23/2025 10:16:29 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Amendment
Approved Date
06/03/2025
Control Number
2025-125
Agenda Item Number
13.D.1.
Entity Name
Blue Cross and Blue Shield of Florida, Inc.
Subject
Amendment No. 1 to Administrative Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
29
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />Employer understands and agrees to reimburse BCBSF and/or its Designated <br />Agent for certain fees and compensation which BCBSF is obligated under the <br />BlueCard Program to pay to the Host Blues, to the Association and/or to <br />vendors of BlueCard Program related services. The specific BlueCard Program <br />fees and compensation that are charged to Employer are set forth in this Exhibit <br />B. BlueCard Program Fees and compensation may be revised from time to <br />time. <br />Only the BlueCard Program access fee may be charged separately each time <br />a claim is processed through the BlueCard Program. All other BlueCard <br />Program related fees are included in the base administrative fee. <br />The Access Fee is charged by the Host Blue to BCBSF and/or its Designated <br />Agent for making its applicable provider network available to Employer's <br />Members. The Access Fee will not apply to nonparticipating provider claims. <br />The Access Fee is charged on a per claim basis and is charged as a <br />percentage of the discount/differential BCBSF and/or its Designated Agent <br />receives from the applicable Host Blue subject to a maximum of $2,000 per <br />claim. When charged BCBSF and/or its Designated Agent pass the access fee <br />directly on to Employer. <br />Instances may occur in which the claim payment is zero or BCBSF and/or its <br />Designated Agent pays only a small amount because the amounts eligible for <br />payment were applied to patient cost sharing (such as a deductible or <br />coinsurance). In these instances, BCBSF and/or its Designated Agent will pay <br />the Host Blue's access fee and pass it along directly to Employer as stated <br />above even though Employer paid little or had no claim liability. <br />A base administrative fee encompasses fees BCBSF and/or its Designated <br />Agent charge to Employer for administering Employer's benefit plan. They may <br />include both local (within BCBSF's Designated Agent's service area, i.e. South <br />Carolina) and Inter -Plan fees. For purposes of this Agreement, they include the <br />following BlueCard Program related fees other than the BlueCard Program <br />access fee: namely, administrative expense allowance (AEA) fee, central <br />financial agency fee, ITS transaction fee, toll free number fee, PPO provider <br />directory fee and Blue Cross Blue Shield Global® Core fees, if applicable. <br />C. Special Cases: Value -Based Programs <br />Value -Based Programs Definitions <br />Accountable Care Organization (ACO): A group of healthcare providers who agree <br />to deliver coordinated care and meet performance benchmarks for quality and <br />affordability in order to manage the total cost of care for their member populations. <br />Global Payment/Total Cost of Care: A payment methodology that is defined at the <br />patient level and accounts for either all patient care or for a specific group of <br />services delivered to the patient such as outpatient, physician, ancillary, hospital <br />services and prescription drugs. <br />
The URL can be used to link to this page
Your browser does not support the video tag.